MEDICARE: JANET HOGAN HARRISON D.D.S. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8768	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0792229	OTHER	GA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1295733897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET HOGAN HARRISON D.D.S. P.C.

Provider Business Mailing Address
First Line	:	108 FIELDSTONE DRIVE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061
Country	:	US
Telephone Number	:	478-453-7535
Fax Number	:	478-453-7536

Provider Business Practice Location Address
First Line	:	108 FIELDSTONE DR
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-7110
Country	:	US
Telephone Number	:	478-453-7535
Fax Number	:	478-453-7536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/10/2014

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