Provider Demographics
NPI:1487826079
Name:BRUNER, HARLAN JASON (MD)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:JASON
Last Name:BRUNER
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:PO BOX 48089
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8089
Mailing Address - Country:US
Mailing Address - Phone:706-389-3740
Mailing Address - Fax:706-389-3951
Practice Address - Street 1:2142 W BROAD ST
Practice Address - Street 2:BUILDING 100, STE 200
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3506
Practice Address - Country:US
Practice Address - Phone:706-548-6881
Practice Address - Fax:706-546-0821
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234690207T00000X
GA64902207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106211AMedicaid