Provider Demographics
NPI:1508802638
Name:HARBIN, GARY STEVEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STEVEN
Last Name:HARBIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 LEBANON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877
Mailing Address - Country:US
Mailing Address - Phone:423-408-2826
Mailing Address - Fax:423-839-2115
Practice Address - Street 1:7460 LEBANON CHURCH RD
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877
Practice Address - Country:US
Practice Address - Phone:423-408-2826
Practice Address - Fax:423-839-2115
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000135304163W00000X
TNAPN0000012402367500000X
TN12402367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I434084Medicare PIN