Provider Demographics
NPI:1447348222
Name:HARRIS, LAURENCE ORIN FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:ORIN FRANKLIN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
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 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-533-6645
Practice Address - Fax:770-535-2642
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40918207R00000X
GA040918208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000691633KOtherPEACH STATE
GA52778931OtherBCBS
GAP00450143OtherMEDICARE RAILROAD
GA341523OtherWELLCARE
GA000691633KMedicaid
GA01071252OtherAMERIGROUP
GA5581447OtherAETNA
GA6638860OtherCIGNA
GAP00450143OtherMEDICARE RAILROAD