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General NPI Number Information
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NPI Number | 1003305707
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Entity Type | Organization
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Legal Business Name | HARLEY'S ENDEAVORS, LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 07/07/2020
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Provider Practice Location Address
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Address Line | 1622 MADISON AVE
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City | TIFTON
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State | GA
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Zip | 31794-3756
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Country | US
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Telephone | 229-387-8061
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Fax | 229-387-8064
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Provider Business Mailing Address
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Address Line | 1622 MADISON AVE
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City | TIFTON
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State | GA
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Zip | 31794-3756
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Country | US
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Telephone | 229-387-8061
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Fax | 229-387-8064
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEWATT MCGRAW SIMS
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Credential | MD
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Telephone | 229-387-8061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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