Provider Demographics
NPI:1962788497
Name:JANET HOGAN HARRISON DDS. P.C.
Entity type:Organization
Organization Name:JANET HOGAN HARRISON DDS. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-453-7535
Mailing Address - Street 1:108 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7110
Mailing Address - Country:US
Mailing Address - Phone:478-453-7535
Mailing Address - Fax:478-453-7536
Practice Address - Street 1:108 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7110
Practice Address - Country:US
Practice Address - Phone:478-453-7535
Practice Address - Fax:478-453-7536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JANET HOGAN HARRISON DDS. P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5813859851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000151126AMedicaid
792229OtherUNITED CONCORDIA IDENTIFIER #
GA9180326OtherDENTAQUEST ( WELLCARE THIRD PARTY PAYER FOR MEDICAID GEORGIA)