1417993643 NPI number — CARROLL M HARMON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417993643 NPI number — CARROLL M HARMON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HARMON

Provider First Name:

CARROLL

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1417993643

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/12/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 55310

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BIRMINGHAM

Provider Business Mailing Address State Name:

AL

Provider Business Mailing Address Postal Code:

35255-5310

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

205-731-9701

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

619 19TH STREET SOUTH

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BIRMINGHAM

Provider Business Practice Location Address State Name:

AL

Provider Business Practice Location Address Postal Code:

35233

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

205-934-4011

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/22/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  23731 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2086S0120X , with the licence number: 23731 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 370018130 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 051520485 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 051060813 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009946865 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 051500217 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 00124774 . This is a "MISSISSIPPI MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
• Identifier: 051520308 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 1425435 . This is a "EMERGENCY LA MEDICAID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
• Identifier: 000060813 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
• Identifier: 009943085 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
• Identifier: 051500217 . This is a "BLUE CROSS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".