Provider Demographics
NPI:1467426023
Name:HARPER, LINA HEATH (MD)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:HEATH
Last Name:HARPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 DARLING AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5223
Mailing Address - Country:US
Mailing Address - Phone:912-283-1717
Mailing Address - Fax:912-283-7633
Practice Address - Street 1:303 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5223
Practice Address - Country:US
Practice Address - Phone:912-283-1717
Practice Address - Fax:912-283-7633
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055237207Q00000X
FLME 86074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA784730256AMedicaid
GADC0134OtherRR MEDICARE
GAGRP6693Medicare ID - Type Unspecified
GAH76213Medicare UPIN