=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255432357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRISON RADIATION ONCOLOGY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 MEDICAL CENTER DR
-----------------------------------------------------
City | GADSDEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35903-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-494-4965
-----------------------------------------------------
Fax | 256-494-4215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1684
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35602-1684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-350-4855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GEORGE LOWNDES HARRISON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-494-4980
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------