Provider Demographics
NPI:1134129562
Name:HARPER, ANDREW S (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:HARPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 WELLBROOK CIR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3872
Mailing Address - Country:US
Mailing Address - Phone:770-922-4024
Mailing Address - Fax:770-761-7179
Practice Address - Street 1:1364 WELLBROOK CIR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3872
Practice Address - Country:US
Practice Address - Phone:770-922-4024
Practice Address - Fax:770-761-7179
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31937208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00417821BMedicaid
GAP00469035OtherMEDICARE RAILROAD
GA511I020036OtherMEDICARE PTAN
GAP00469035OtherMEDICARE RAILROAD
020013408Medicare ID - Type UnspecifiedRAILROAD MEDICARE
02BDBGJMedicare ID - Type Unspecified