Provider Demographics
NPI:1154352599
Name:HARBIN, REGINALD BRENT (DPM)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:BRENT
Last Name:HARBIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5816
Mailing Address - Country:US
Mailing Address - Phone:865-983-0819
Mailing Address - Fax:865-983-3265
Practice Address - Street 1:417 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5816
Practice Address - Country:US
Practice Address - Phone:865-983-0819
Practice Address - Fax:865-983-3265
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM559213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3353268Medicaid
TN103I481316Medicare PIN
TN3353269Medicare ID - Type Unspecified