Provider Demographics
NPI:1487686036
Name:HARRISON, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HARRISON
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 1:850 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-4886
Mailing Address - Country:US
Mailing Address - Phone:678-223-8483
Mailing Address - Fax:
Practice Address - Street 1:5126 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2566
Practice Address - Country:US
Practice Address - Phone:334-386-2053
Practice Address - Fax:334-244-1830
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033983207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA810642548AMedicaid
GAP00125959OtherRAILROAD MEDICARE PROV #
GA05BDKCDMedicare ID - Type UnspecifiedMEDICARE PROV #
GA810642548AMedicaid
GAP00125959OtherRAILROAD MEDICARE PROV #