Healthcare Provider Details

I. General information

NPI: 1831388982
Provider Name (Legal Business Name): FAWN G HARRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAWN A GRIGSBY M.D.

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N MILLS AVE
ARCADIA FL
34266-8716
US

IV. Provider business mailing address

815 N MILLS AVE
ARCADIA FL
34266-8716
US

V. Phone/Fax

Practice location:
  • Phone: 863-491-7580
  • Fax: 863-491-7584
Mailing address:
  • Phone: 863-491-7580
  • Fax: 863-491-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME102181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: