MEDICARE: FITZCLARENCE N HARPER MD

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
1	207L00000X	Anesthesiology Physician	GA036773	GA
2	208VP0000X	Pain Medicine Physician	GA 036773	GA

General Provider Information

NPI Number	:	1962433508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FITZCLARENCE N HARPER MD

Provider Business Mailing Address
First Line	:	1506 ROCK QUARRY RD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5047
Country	:	US
Telephone Number	:	678-782-7999
Fax Number	:	404-334-7274

Provider Business Practice Location Address
First Line	:	1506 ROCK QUARRY RD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-5047
Country	:	US
Telephone Number	:	678-782-7999
Fax Number	:	404-334-7274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/29/2023

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