Healthcare Provider Details

I. General information

NPI: 1447385158
Provider Name (Legal Business Name): HARBIN CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MARTHA BERRY BLVD NW
ROME GA
30165-1625
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 706-295-5331
  • Fax: 706-238-8011
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number057-251
License Number StateGA

VIII. Authorized Official

Name: KENNA STOCK
Title or Position: CEO MEDICAL GROUP
Credential:
Phone: 762-235-1165