Provider Demographics
NPI:1336590306
Name:HARRISON, GEORGE MAXIE III (APRN NP-C)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MAXIE
Last Name:HARRISON
Suffix:III
Gender:M
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RAINBOW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4155
Mailing Address - Country:US
Mailing Address - Phone:843-942-9960
Mailing Address - Fax:843-799-5088
Practice Address - Street 1:300 RAINBOW DR STE 102
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4155
Practice Address - Country:US
Practice Address - Phone:843-942-9960
Practice Address - Fax:843-799-5088
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.20312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4543Medicaid