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General NPI Number Information
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NPI Number | 1518140524
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Entity Type | Organization
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Legal Business Name | THERON HARRISON, D.O., PC
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 108 FIELDSTONE DR
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-7110
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Country | US
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Telephone | 478-453-3532
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Fax | 478-453-4496
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | MILLEDGEVILLE
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State | GA
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Zip | 31059-1329
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Country | US
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Telephone | 478-453-3532
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Fax | 478-453-4496
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. THERON GERARD HARRISON
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Credential | D.O.
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Telephone | 478-453-3532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 051143
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License Number State | GA
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