Healthcare Provider Details

I. General information

NPI: 1417087768
Provider Name (Legal Business Name): DEANA L HARMON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BAYLOR DR STE 200
BLUFFTON SC
29910-8965
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 843-540-5857
  • Fax: 843-524-5655
Mailing address:
  • Phone: 423-857-2093
  • Fax: 423-857-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101015578
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number83212
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO1853
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: