Provider Demographics
NPI:1922073659
Name:GARRISON, WARREN BAKER (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:BAKER
Last Name:GARRISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ALPINE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223
Mailing Address - Country:US
Mailing Address - Phone:803-779-3548
Mailing Address - Fax:803-779-7055
Practice Address - Street 1:125 ALPINE CIRCLE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-779-3548
Practice Address - Fax:803-779-7055
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC72442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400186Medicaid
SC072441Medicaid
582296052001OtherBCBS PALMETTO HEALTH
582296052001OtherBCBS PALMETTO HEALTH