Provider Demographics
NPI:1720426695
Name:GARRISON, JOEL R (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:GARRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOEL
Other - Middle Name:ROBERT
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2161 W SPRING ST STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-3196
Mailing Address - Country:US
Mailing Address - Phone:770-267-8467
Mailing Address - Fax:770-267-1600
Practice Address - Street 1:2161 W SPRING ST STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655
Practice Address - Country:US
Practice Address - Phone:770-267-8467
Practice Address - Fax:770-267-1600
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12922207Q00000X
GA76549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine