Provider Demographics
NPI:1396730701
Name:GARRISON, THOMAS J (PA C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:GARRISON
Suffix:
Gender:M
Credentials:PA C
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Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-277-7129
Mailing Address - Fax:859-277-9613
Practice Address - Street 1:4071 TATES CREEK CENTRE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3062
Practice Address - Country:US
Practice Address - Phone:859-277-7129
Practice Address - Fax:859-277-9613
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95004396Medicaid
KY0028117Medicare PIN
KY95004396Medicaid
KY0356405Medicare PIN
KY95004396Medicaid
KY0356405Medicare PIN