Healthcare Provider Details

I. General information

NPI: 1205427986
Provider Name (Legal Business Name): JOASH BRIAN HARCEY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 SAINT SEBASTIAN WAY STE 311
AUGUSTA GA
30901-2653
US

IV. Provider business mailing address

PO BOX 925
AUGUSTA GA
30903-0925
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-3473
  • Fax:
Mailing address:
  • Phone: 706-854-6008
  • Fax: 706-774-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10125
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: