Provider Demographics
NPI:1053929224
Name:WALDRON, HARRISON TANNER (RN)
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:TANNER
Last Name:WALDRON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 RIDGE VLY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-7048
Mailing Address - Country:US
Mailing Address - Phone:419-672-9141
Mailing Address - Fax:
Practice Address - Street 1:8051 RIDGE VLY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-7048
Practice Address - Country:US
Practice Address - Phone:419-672-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN276981163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health