Provider Demographics
NPI:1497044028
Name:HARPER, ALFRED JACOB II (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:JACOB
Last Name:HARPER
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3340 PLAYERS CLUB PKWY
Mailing Address - Street 2:STE 350
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8933
Mailing Address - Country:US
Mailing Address - Phone:901-844-1590
Mailing Address - Fax:901-844-1592
Practice Address - Street 1:630 13TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1015
Practice Address - Country:US
Practice Address - Phone:478-832-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN071381367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109239CMedicaid
GA580628385OtherTRICARE
GA593279OtherWELLCARE
GA003109239DMedicaid
GA003109239BMedicaid
GAP00944978OtherRAILROAD MEDICARE
GA003109239AMedicaid
GA003109239BMedicaid