Provider Demographics
NPI:1770806804
Name:GARZONE, JUSTIN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:GARZONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CENTRAL HAVEN DR
Mailing Address - Street 2:APT 1115
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3791
Mailing Address - Country:US
Mailing Address - Phone:862-432-2967
Mailing Address - Fax:
Practice Address - Street 1:1200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3251
Practice Address - Country:US
Practice Address - Phone:843-375-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1307207R00000X, 208M00000X
NC2013-01843208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC013078Medicaid
NC1770806804Medicaid
SC1307OtherSTATE LICENSE
SC013078Medicaid
SC1307OtherSTATE LICENSE