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

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	Executive Management Our Location Press Room News & Events Join Our Team Contact Us	Locum Tenens Jobs Enter Job Number Apply Online Email Job Alerts Why Locum Tenens? Licensing Credentialing Documents & Forms Career Newsletter Physician Resources	Request Coverage Relationship for Success Why Use an Agency?	Government Opportunities	Contact Information Our Location

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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