Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 021992 | GA |
NPI | 1174596712 |
---|---|
Provider Name | John Douglas Harmon |
First Address | Evans, GA 30809-3000 |
Second Address | Evans, GA 30809-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 05/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002033988 | (05) | GA |
040002259 | MEDICARE RAILROAD (01) | GA |
2696932 | CIGNA (01) | GA |
4136537 | AETNA (01) | |
572591 | BLUE CROSS (01) | GA |
D40063 | (02) |