Provider Demographics
NPI:1326245382
Name:D. CONRAD HARPER, MD LLC
Entity Type:Organization
Organization Name:D. CONRAD HARPER, MD LLC
Other - Org Name:DENNIS C. HARPER, MD.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-384-3838
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 1:102 BOWENS MILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2250
Practice Address - Country:US
Practice Address - Phone:912-384-3838
Practice Address - Fax:912-384-8847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA843434306KMedicaid
GA843434306KMedicaid
GA840434306DMedicaid
GA843434306KMedicaid