Provider Demographics
NPI:1164263919
Name:HARBIN, JACKSON ALEXANDER (PA-C)
Entity type:Individual
Prefix:MR
First Name:JACKSON
Middle Name:ALEXANDER
Last Name:HARBIN
Suffix:
Gender:M
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 1:205 SONATA CIR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4939
Mailing Address - Country:US
Mailing Address - Phone:407-730-1299
Mailing Address - Fax:
Practice Address - Street 1:865 S 1ST ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0210
Practice Address - Country:US
Practice Address - Phone:912-530-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12355207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services