Provider Demographics
NPI:1427186675
Name:GARRISON, JONATHAN MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:GARRISON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-0820
Mailing Address - Country:US
Mailing Address - Phone:931-454-9994
Mailing Address - Fax:931-455-5086
Practice Address - Street 1:11145 TULLAHOMA HWY
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-6016
Practice Address - Country:US
Practice Address - Phone:931-454-9994
Practice Address - Fax:931-455-5086
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002359103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3585203Medicaid
TN3585203Medicaid