Provider Demographics
NPI:1982149951
Name:HARBIN, JONATHAN RUDOLPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:RUDOLPH
Last Name:HARBIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8903
Mailing Address - Country:US
Mailing Address - Phone:205-221-5374
Mailing Address - Fax:205-385-0382
Practice Address - Street 1:2950 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8903
Practice Address - Country:US
Practice Address - Phone:205-221-5374
Practice Address - Fax:205-385-0382
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA1225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant