Provider Demographics
NPI:1861418824
Name:GARRISON-STIGALL, BEVERLY (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:GARRISON-STIGALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:11402 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7557
Practice Address - Country:US
Practice Address - Phone:864-631-2799
Practice Address - Fax:864-522-1215
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14601207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC21-4601OtherSC CONTROLLED SUBS
SC57-6007863OtherBLUE CROSS
SC576007863OtherAETNA
SC146014Medicaid
SC57-6007863OtherBLUE CHOICE
SC576007863OtherTRICARE
SC20009735OtherSELECT HEALTH INDV
SC20031678OtherSELECT HEALTH GRP
SC576007863OtherAETNA
SC21-4601OtherSC CONTROLLED SUBS
SC20009735OtherSELECT HEALTH INDV