Provider Demographics
NPI:1568068658
Name:GARRISON, ANTHONY LIONEL
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LIONEL
Last Name:GARRISON
Suffix:
Gender:M
Credentials:
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 537
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-0537
Mailing Address - Country:US
Mailing Address - Phone:318-336-4797
Mailing Address - Fax:318-336-4799
Practice Address - Street 1:1810 CARTER ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3115
Practice Address - Country:US
Practice Address - Phone:318-336-4797
Practice Address - Fax:318-336-4799
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician