Basic Information
| Provider Information | |||||||||
| NPI: | 1417993643 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMON | ||||||||
| FirstName: | CARROLL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55310 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057319701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 619 19TH STREET SOUTH | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 23731 | AL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | 23731 | AL | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 370018130 | 01 | AL | RAILROAD MEDICARE | OTHER | 051520485 | 01 | AL | BLUE CROSS | OTHER | 051060813 | 01 | AL | BLUE CROSS | OTHER | 009946865 | 05 | AL | MEDICAID | 051500217 | 05 | AL | MEDICAID | 00124774 | 01 | MS | MISSISSIPPI MEDICAID | OTHER | 051520308 | 01 | AL | BLUE CROSS | OTHER | 1425435 | 01 | LA | EMERGENCY LA MEDICAID | OTHER | 000060813 | 01 | AL | BLUE CROSS | OTHER | 009943085 | 05 | AL | MEDICAID | 051500217 | 01 | AL | BLUE CROSS | OTHER |