Basic Information
| Provider Information | |||||||||
| NPI: | 1043203425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARPER | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | CONRAD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 NW BOWENS MILL ROAD | ||||||||
| Address2: | |||||||||
| City: | DOUGLAS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315332252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123843838 | ||||||||
| FaxNumber: | 9123844029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 N. PETERSON AVENUE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | DOUGLAS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123844000 | ||||||||
| FaxNumber: | 9123844085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 10/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 053749 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 053749 | 01 | GA | STATE LICENSE | OTHER | 840434306E | 05 | GA | MEDICAID | 843434306K | 05 | GA | MEDICAID | 840434306D | 05 | GA | MEDICAID | 840434306C | 05 | GA | MEDICAID | 840434306B | 05 | GA | MEDICAID |