# THERON HARRISON, D.O., PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518140524
- **Authorized official:** DR. THERON GERARD HARRISON D.O. (CEO/OWNER)
- **Authorized official phone:** (478) 453-3532

## Contact information

- **Practice address:** 108 FIELDSTONE DR, MILLEDGEVILLE, GA 31061-7110
- **Practice address phone:** (478) 453-3532
- **Practice address fax:** (478) 453-4496
- **Mailing address:** PO BOX 1329, MILLEDGEVILLE, GA 31059-1329
- **Mailing address phone:** (478) 453-3532
- **Mailing address fax:** (478) 453-4496

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 051143 | GA | Yes |

## Other

- **Enumeration date:** 12/12/2007
- **Last updated:** 12/12/2007