Basic Information
| Provider Information | |||||||||
| NPI: | 1417087768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARMON | ||||||||
| FirstName: | DEANA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376620009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238572093 | ||||||||
| FaxNumber: | 4238572012 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 BAYLOR DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299108965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435405857 | ||||||||
| FaxNumber: | 8435245655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101015578 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 83212 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | DO1853 | TN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 114551918 | 05 | MI | MEDICAID | 33000131 | 05 | TN | MEDICAID | 1417087768 | 05 | VA | MEDICAID | 3720181 | 05 | TN | MEDICAID |