Provider Demographics
NPI:1679360812
Name:ROSE, GARRISON
Entity type:Individual
Prefix:
First Name:GARRISON
Middle Name:
Last Name:ROSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 SPINNAKER WYND
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:GA
Mailing Address - Zip Code:31565-5404
Mailing Address - Country:US
Mailing Address - Phone:912-506-3971
Mailing Address - Fax:
Practice Address - Street 1:855 SPINNAKER WYND
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:GA
Practice Address - Zip Code:31565-5404
Practice Address - Country:US
Practice Address - Phone:912-506-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer