Individual
JUSTIN GARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9 WASHINGTON AVE STE 3A, HAMDEN, CT 06518-3267
(475) 227-3614
(844) 219-8679
Mailing address
67 MAPLE AVE, DERBY, CT 06418-1328
(203) 732-1256
(203) 732-1539
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5259
CT
363A00000X
Physician Assistant
PA08298
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
316913801
—
TX
01
—
8024NA
BCBS
TX
Enumeration date
01/07/2013
Last updated
07/26/2021
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