Provider Demographics
NPI:1043203425
Name:HARPER, DENNIS CONRAD (MD)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:CONRAD
Last Name:HARPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NW BOWENS MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2252
Mailing Address - Country:US
Mailing Address - Phone:912-384-3838
Mailing Address - Fax:912-384-4029
Practice Address - Street 1:1400 N. PETERSON AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533
Practice Address - Country:US
Practice Address - Phone:912-384-4000
Practice Address - Fax:912-384-4085
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053749OtherSTATE LICENSE
GA840434306EMedicaid
GA843434306KMedicaid
GA840434306DMedicaid
GA840434306CMedicaid
GA840434306BMedicaid
GA840434306CMedicaid
GA840434306BMedicaid
GA840434306DMedicaid