Provider Demographics
NPI:1235701871
Name:HARRISON, TELEMACHUS GIRARD (LPN)
Entity type:Individual
Prefix:
First Name:TELEMACHUS
Middle Name:GIRARD
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 ALAMANCE RD STE D
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6178
Mailing Address - Country:US
Mailing Address - Phone:336-350-7858
Mailing Address - Fax:336-350-9546
Practice Address - Street 1:408 ALAMANCE RD STE D
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6178
Practice Address - Country:US
Practice Address - Phone:336-350-7858
Practice Address - Fax:336-350-9546
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89355164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21683OtherPROVIDER IDENTIFICATION