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NPI Code Detail

MEDICARE: JEFFREY G HARRISON PA-C

MEDICARE: JEFFREY G HARRISON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant102551NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAL LICENSEOTHERNC102680

General Provider Information

NPI Number : 1205825601
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY G HARRISON PA-C
Provider Business Mailing Address
First Line : 201 N BREAZEALE AVE
Second Line :
City : MOUNT OLIVE
State : NC
Zip : 28365-1603
Country : US
Telephone Number : 919-658-4954
Fax Number : 919-581-4966
Provider Business Practice Location Address
First Line : 201 N BREAZEALE AVE
Second Line :
City : MOUNT OLIVE
State : NC
Zip : 28365-1603
Country : US
Telephone Number : 919-658-4954
Fax Number : 919-581-4966
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 02/20/2014

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