Provider Demographics
NPI:1043481336
Name:HARRISON, JOHN ARTHUR (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-257-9234
Mailing Address - Fax:703-730-7236
Practice Address - Street 1:9001 DIGGES RD
Practice Address - Street 2:SUITE 204
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4421
Practice Address - Country:US
Practice Address - Phone:703-257-9234
Practice Address - Fax:703-730-7236
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014225208600000X
VA0102202370208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11955353OtherANTHEM
VA11955353OtherANTHEM