=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295733897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANET HOGAN HARRISON D.D.S. P.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2005
-----------------------------------------------------
Last Update Date | 02/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 FIELDSTONE DR
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061-7110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-453-7535
-----------------------------------------------------
Fax | 478-453-7536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 FIELDSTONE DRIVE
-----------------------------------------------------
City | MILLEDGEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-453-7535
-----------------------------------------------------
Fax | 478-453-7536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8768
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------