Provider Demographics
NPI:1508032913
Name:GARRISON, ALAN AUTRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:AUTRY
Last Name:GARRISON
Suffix:
Gender:M
Credentials:PHD
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 6725
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30065-0725
Mailing Address - Country:US
Mailing Address - Phone:770-594-2601
Mailing Address - Fax:770-594-2607
Practice Address - Street 1:10927 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3032
Practice Address - Country:US
Practice Address - Phone:770-594-2601
Practice Address - Fax:770-594-2607
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000610106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist