Provider Demographics
NPI:1679116065
Name:GARRICK, KATRINA HARRIS
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:HARRIS
Last Name:GARRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 DENBY CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7784
Mailing Address - Country:US
Mailing Address - Phone:803-722-4000
Mailing Address - Fax:
Practice Address - Street 1:112 DENBY CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7784
Practice Address - Country:US
Practice Address - Phone:803-722-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC177208374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide