Provider Demographics
NPI:1750134060
Name:GARRISON, VERNON DELWOOD SR
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:DELWOOD
Last Name:GARRISON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5020
Mailing Address - Country:US
Mailing Address - Phone:252-412-8211
Mailing Address - Fax:
Practice Address - Street 1:1530 EVANS ST STE 205
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5303
Practice Address - Country:US
Practice Address - Phone:252-321-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC7150372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion