Provider Demographics
NPI:1730303827
Name:GARY B GARISON M.D. P.A.
Entity Type:Organization
Organization Name:GARY B GARISON M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KANDI
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:MSHM
Authorized Official - Phone:910-587-9590
Mailing Address - Street 1:3688 PIONEER DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-9346
Mailing Address - Country:US
Mailing Address - Phone:910-587-9590
Mailing Address - Fax:919-287-2269
Practice Address - Street 1:3625 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4457
Practice Address - Country:US
Practice Address - Phone:910-587-9590
Practice Address - Fax:919-287-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16785261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934559Medicaid
NC8934559Medicaid
NCC80600Medicare UPIN