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General NPI Number Information
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NPI Number | 1851300842
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Entity Type | Organization
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Legal Business Name | HARALSON MEDICAL CLINIC, PC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 201 ALLEN MEMORIAL DR
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City | BREMEN
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State | GA
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Zip | 30110
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Country | US
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Telephone | 770-537-4818
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Fax | 770-537-6684
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Provider Business Mailing Address
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Address Line | 201 ALLEN MEMORIAL DR
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City | BREMEN
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State | GA
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Zip | 30110
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Country | US
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Telephone | 770-537-4818
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Fax | 770-537-6684
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Authorized Official
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Title or Position | SECRETARY
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Name | IN SOOK KIM
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Credential | MD
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Telephone | 770-537-4818
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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 | 16085
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License Number State | GA
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