Provider Demographics
NPI:1447249248
Name:HARROD, GEORGIA P (PA C)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:P
Last Name:HARROD
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:STE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-845-5672
Mailing Address - Fax:502-845-1402
Practice Address - Street 1:150 FAIRVIEW CT
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019-1158
Practice Address - Country:US
Practice Address - Phone:502-845-5672
Practice Address - Fax:502-845-1402
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100127020Medicaid
000000336045OtherANTHEM
KY7100127020Medicaid
KYP400017521Medicare Oscar/Certification
000000336045OtherANTHEM