Healthcare Provider Details

I. General information

NPI: 1588631212
Provider Name (Legal Business Name): KISHORE J. HARJAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOSPITAL DR STE 330
MACON GA
31217-3895
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4093
US

V. Phone/Fax

Practice location:
  • Phone: 478-200-8152
  • Fax:
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD421879
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number105124
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number14135-320
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036161255
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number14135-320
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2021014024
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: