Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 006442 | GA |
NPI | 1003089061 |
---|---|
Provider Name | Mr. Gordon B Harrison II |
First Address | Atlanta, GA 30339-3035 |
Second Address | Newnan, GA 30265-2323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 03/06/2014 |