Healthcare Provider Details

I. General information

NPI: 1750342085
Provider Name (Legal Business Name): ANDREW P HARAKAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601-A PROFESSIONAL DRIVE SUITE 130
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

PO BOX 150
WATKINSVILLE GA
30677-0004
US

V. Phone/Fax

Practice location:
  • Phone: 678-551-7800
  • Fax: 678-551-7802
Mailing address:
  • Phone: 678-551-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: