MEDICARE: ROBERT PAUL HARRIS AS, RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-20-145817	GA

General Provider Information

NPI Number	:	1285238774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PAUL HARRIS AS, RBT

Provider Business Mailing Address
First Line	:	3545 ELK HORN TRL SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8797
Country	:	US
Telephone Number	:	770-882-4971
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 ELK HORN TRL SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8797
Country	:	US
Telephone Number	:	770-882-4971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	11/24/2020

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