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General NPI Number Information
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NPI Number | 1508545021
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Entity Type | Individual
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Provider Name | JOSEPH ALEXANDER HARRISON LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/12/2023
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 989 HIGHWAY 114
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City | SUMMERVILLE
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State | GA
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Zip | 30747-1595
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Country | US
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Telephone | 706-857-2402
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Fax |
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Provider Business Mailing Address
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Address Line | 41 WINDMILL DR SE
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City | SILVER CREEK
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State | GA
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Zip | 30173-3260
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Country | US
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Telephone | 706-622-7733
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT004664
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License Number State | GA
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