Locum Tenens Staffing Coverage Form | Harris Medical Associates

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locum tenens coverage form
INFORMATION FOR PRACTICES & FACILITIES

To request locum tenens staffing coverage, please complete the form below, and click
"Send Request" when finished. Thank you for your interest in Harris Medical Associates.

CONTACT INFORMATION

* Indicates a required field

* Contact First Name

* Contact Last Name

* E-mail Address

Please use your primary work e-mail address

* Phone Number

Please use 111-1111-1111 format

Mobile Phone Number

Not required. Please use 111-1111-1111 format

Other Phone Number

Not required. Please use 111-1111-1111 format

Fax Number

Not required. Please use 111-1111-1111 format

COMPANY INFORMATION

* Company Name

* Website Address

* Specialty Needed

* Street Address 1

Street Address 2

* City

* State

* Zip Code

* How Did You Hear about Us?

Tell Us About Your Needs

Note: By sending this coverage request, you will be receive a monthly locums coverage availability notification. You may unsubscribe from these notifications at any time.

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Harris Medical Associates
1180 Satellite Blvd., Suite 200, Suwanee, GA 30024
Call us toll-free: (800) 980-2385

Harris Medical is a member of NALTO

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