Provider Demographics
NPI:1982750048
Name:HARPER & ASSOCIATES FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:HARPER & ASSOCIATES FAMILY MEDICINE, P.C.
Other - Org Name:KENNETH HARPER, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-418-2120
Mailing Address - Street 1:P.O. BOX 856
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058
Mailing Address - Country:US
Mailing Address - Phone:678-418-2120
Mailing Address - Fax:678-418-2936
Practice Address - Street 1:5910 HILLANDALE DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:678-418-2120
Practice Address - Fax:678-418-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035182207Q00000X
GA055830207Q00000X
GA004798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00794912CMedicaid
GA004798OtherAMBROZINE TRENTJOHNNEY PA
GA170986344AMedicaid
GA08BBWRTMedicare PIN
GA170986344AMedicaid