Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0126003140 | VA |
Y | 213ES0000X | Sports Medicine | 0126003140 | VA |
NPI | 1053959684 |
---|---|
Provider Name | Dontonio Garrison |
First Address | Hampton, VA 23666-1305 |
Second Address | Hampton, VA 23668-0108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2019 |
Last Update Date | 13/12/2019 |