Provider Demographics
NPI:1609004779
Name:HARRISON, JOHN ALTON (IDMT USAF)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALTON
Last Name:HARRISON
Suffix:
Gender:M
Credentials:IDMT USAF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WINDERMERE CIR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4109
Mailing Address - Country:US
Mailing Address - Phone:478-327-1893
Mailing Address - Fax:
Practice Address - Street 1:104 WINDERMERE CIR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4109
Practice Address - Country:US
Practice Address - Phone:478-327-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians