Provider Demographics
NPI:1750342085
Name:HARAKAS, ANDREW P (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:HARAKAS
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:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0004
Mailing Address - Country:US
Mailing Address - Phone:678-551-7800
Mailing Address - Fax:
Practice Address - Street 1:601-A PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:678-551-7800
Practice Address - Fax:678-551-7802
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32393207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA17050342085Medicaid
GA202I206610OtherMEDICARE PTAN
GA003149135AMedicaid
VA17050342085OtherMEDICARE