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NPI Code Detail

MEDICARE: HARBIN CLINIC, LLC

MEDICARE: HARBIN CLINIC, LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1619020377
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARBIN CLINIC, LLC
Provider Business Mailing Address
First Line : 221 TECHNOLOGY PKWY NW
Second Line :
City : ROME
State : GA
Zip : 30165-1369
Country : US
Telephone Number : 762-235-1000
Fax Number :
Provider Business Practice Location Address
First Line : 123 THREE RIVERS DR NE
Second Line : SUITE 100
City : ROME
State : GA
Zip : 30161-2300
Country : US
Telephone Number : 706-291-6848
Fax Number : 706-291-6823
Authorized Official
Title or Position : PRESIDENT
Name : KENNETH FRANKLIN DAVIS
Credential : MD
Telephone Number : 762-235-1000
Provider Enumeration Date : 01/18/2007
Last Update Date : 02/05/2019

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