=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447254289
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES SEAN HARPER O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2005
-----------------------------------------------------
Last Update Date | 01/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1239 CONCORD RD SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-435-4457
-----------------------------------------------------
Fax | 770-435-4555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1239 CONCORD RD SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-435-4457
-----------------------------------------------------
Fax | 770-435-4555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1791
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------