Provider Demographics
NPI:1346279676
Name:HARRISON, LONNIE R (DMD)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:R
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ALTON HALL RD
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828
Mailing Address - Country:US
Mailing Address - Phone:229-377-1350
Mailing Address - Fax:229-377-1320
Practice Address - Street 1:80 ALTON HALL RD
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828
Practice Address - Country:US
Practice Address - Phone:229-377-1350
Practice Address - Fax:229-377-1320
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA123481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice