Provider Demographics
NPI:1962433508
Name:HARPER, FITZCLARENCE N (MD)
Entity type:Individual
Prefix:
First Name:FITZCLARENCE
Middle Name:N
Last Name:HARPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5047
Mailing Address - Country:US
Mailing Address - Phone:678-782-7999
Mailing Address - Fax:404-334-7274
Practice Address - Street 1:1506 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5047
Practice Address - Country:US
Practice Address - Phone:678-782-7999
Practice Address - Fax:404-334-7274
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA036773207L00000X, 208VP0014X
GAGA 036773208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F60618Medicare UPIN
GA000524913QMedicaid
GA05BDHKVMedicare ID - Type Unspecified