Healthcare Provider Details

I. General information

NPI: 1851458467
Provider Name (Legal Business Name): DRS CHISHOLM HARRISON SANDIFER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6721 GOVERNMENT ST STE D
BATON ROUGE LA
70806
US

IV. Provider business mailing address

6721 GOVERNMENT ST STE D
BATON ROUGE LA
70806
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-2160
  • Fax: 225-923-3009
Mailing address:
  • Phone: 225-923-2160
  • Fax: 225-923-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3158
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3128
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4584
License Number StateLA

VIII. Authorized Official

Name: DR. GEORGE W HARRISON IV
Title or Position: OWNER PARTNER
Credential: DMD
Phone: 225-923-2160