Healthcare Provider Details

I. General information

NPI: 1760943765
Provider Name (Legal Business Name): PETER P. HARIMTEPATHIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HOSPITAL DR STE 210
MACON GA
31217-8026
US

IV. Provider business mailing address

310 HOSPITAL DR STE 210
MACON GA
31217-8026
US

V. Phone/Fax

Practice location:
  • Phone: 478-787-6255
  • Fax:
Mailing address:
  • Phone: 478-787-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0100579
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number105226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: