Healthcare Provider Details

I. General information

NPI: 1982750048
Provider Name (Legal Business Name): HARPER & ASSOCIATES FAMILY MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 HILLANDALE DRIVE SUITE 301
LITHONIA GA
30058
US

IV. Provider business mailing address

P.O. BOX 856
LITHONIA GA
30058
US

V. Phone/Fax

Practice location:
  • Phone: 678-418-2120
  • Fax: 678-418-2936
Mailing address:
  • Phone: 678-418-2120
  • Fax: 678-418-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004798
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number035182
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number055830
License Number StateGA

VIII. Authorized Official

Name: KENNETH HARPER
Title or Position: PRESIDENT
Credential: MD
Phone: 678-418-2120