Provider Demographics
NPI:1689336471
Name:BOYDE J HARRISON, M.D.
Entity Type:Organization
Organization Name:BOYDE J HARRISON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JAVA MEDICAL GROUP CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHOKE 'BAPPA'
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKHERJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-308-8800
Mailing Address - Street 1:42024 HWY 195
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565
Mailing Address - Country:US
Mailing Address - Phone:205-485-7108
Mailing Address - Fax:205-485-7177
Practice Address - Street 1:904 26TH STREET
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565
Practice Address - Country:US
Practice Address - Phone:205-486-5234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKELAND COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL243660Medicaid