Provider Demographics
NPI:1982695672
Name:HARBISON, MARY ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALICE
Last Name:HARBISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 WESTWOOD PL
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1401
Mailing Address - Country:US
Mailing Address - Phone:615-371-3000
Mailing Address - Fax:615-371-3089
Practice Address - Street 1:105 WESTWOOD PL
Practice Address - Street 2:SUITE 350
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1401
Practice Address - Country:US
Practice Address - Phone:615-371-3000
Practice Address - Fax:615-371-3089
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD20393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE81396Medicare UPIN
TN3058930Medicare ID - Type Unspecified