Provider Demographics
NPI:1679223945
Name:HARMON, JUSTIN LEE
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:HARMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVENUE C BUILDING
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130
Mailing Address - Country:US
Mailing Address - Phone:304-369-6400
Mailing Address - Fax:
Practice Address - Street 1:1 AVE C 110
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130
Practice Address - Country:US
Practice Address - Phone:304-369-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant