Provider Demographics
NPI:1285907212
Name:GARRISON, HOLLY ANN (DC)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANN
Last Name:GARRISON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WESTSHORE DR # 102
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9277
Mailing Address - Country:US
Mailing Address - Phone:470-978-1717
Mailing Address - Fax:
Practice Address - Street 1:2100 WESTSHORE DR # 102
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9277
Practice Address - Country:US
Practice Address - Phone:470-978-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV938111N00000X
GACHIR009483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022854Medicaid
WVWV12410281OtherMEDICARE PTAN