Provider Demographics
NPI:1982833117
Name:HARBISON, KAMESHA (MD)
Entity type:Individual
Prefix:
First Name:KAMESHA
Middle Name:
Last Name:HARBISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMESHA
Other - Middle Name:
Other - Last Name:FAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 12347
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31917-2347
Mailing Address - Country:US
Mailing Address - Phone:706-989-4955
Mailing Address - Fax:706-989-4956
Practice Address - Street 1:2000 10TH AVE STE 150
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3702
Practice Address - Country:US
Practice Address - Phone:706-989-4955
Practice Address - Fax:706-507-3047
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069589207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003138694Medicaid
AL159372Medicaid
GA202I65090Medicare Oscar/Certification