Healthcare Provider Details

I. General information

NPI: 1841188000
Provider Name (Legal Business Name): HARRIS ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

2111 WOODLAND AVE
AUGUSTA GA
30904-5031
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number17777
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: