Basic Information
| Provider Information | |||||||||
| NPI: | 1447348222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | LAURENCE | ||||||||
| MiddleName: | ORIN FRANKLIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 743 SPRING ST NE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705336645 | ||||||||
| FaxNumber: | 7705352642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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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 | 207R00000X | 40918 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 040918 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000691633K | 01 | PEACH STATE | OTHER | 52778931 | 01 | GA | BCBS | OTHER | P00450143 | 01 | GA | MEDICARE RAILROAD | OTHER | 341523 | 01 | GA | WELLCARE | OTHER | 000691633K | 05 | GA | MEDICAID | 01071252 | 01 | GA | AMERIGROUP | OTHER | 5581447 | 01 | GA | AETNA | OTHER | 6638860 | 01 | GA | CIGNA | OTHER |