Healthcare Provider Details

I. General information

NPI: 1982149951
Provider Name (Legal Business Name): JONATHAN RUDOLPH HARBIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 HIGHWAY 78 E
JASPER AL
35501-8903
US

IV. Provider business mailing address

2950 HIGHWAY 78 E
JASPER AL
35501-8903
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-5374
  • Fax: 205-385-0382
Mailing address:
  • Phone: 205-221-5374
  • Fax: 205-385-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1225
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: