Provider Demographics
NPI:1760687131
Name:GARRISS, GEORGE WALDON III (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WALDON
Last Name:GARRISS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G.
Other - Middle Name:WALDON
Other - Last Name:GARRISON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-936-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51134207R00000X, 208000000X
TN28763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3840540OtherMEDICARE ID-TYPE UNSPECIFIED
GA3840540Medicaid
GAG51659Medicare UPIN