Provider Demographics
NPI:1417087768
Name:HARMON, DEANA L (DO)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:L
Last Name:HARMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-857-2012
Practice Address - Street 1:75 BAYLOR DR STE 200
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8965
Practice Address - Country:US
Practice Address - Phone:843-540-5857
Practice Address - Fax:843-524-5655
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015578207V00000X
SC83212207V00000X
TNDO1853207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114551918Medicaid
TN33000131Medicaid
VA1417087768Medicaid
TN3720181Medicaid
TN33000131Medicare PIN
TN3700592Medicare PIN
VA1417087768Medicaid
VA015739H81Medicare PIN
TN33000131Medicaid
TN0281780003Medicare PIN
TN0281780001Medicare PIN