Individual
BRIAN A HARBISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
311 CLUB COLONY CIRCLE, BLYTHEWOOD, SC 29016-8282
(843) 788-5916
Mailing address
PO BOX 1218, WINNSBORO, SC 29180-5218
(843) 754-1195
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A594
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A594
STATE LICENSE #
SC
Enumeration date
05/18/2006
Last updated
07/09/2010
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