Provider Demographics
NPI:1891225108
Name:GARRIS, MAURICE VAN
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:VAN
Last Name:GARRIS
Suffix:
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 1:4016 THOMAS JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1913
Mailing Address - Country:US
Mailing Address - Phone:757-933-9897
Mailing Address - Fax:
Practice Address - Street 1:6062 CLEAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4638
Practice Address - Country:US
Practice Address - Phone:757-933-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No372600000XNursing Service Related ProvidersAdult Companion