MEDICARE: LAURA EFFINGER HARRIS M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	054494	GA

General Provider Information

NPI Number	:	1295721348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA EFFINGER HARRIS M.D.

Provider Business Mailing Address
First Line	:	105 COLLIER RD NW
Second Line	:	SUITE 4060
City	:	ATLANTA
State	:	GA
Zip	:	30309-1710
Country	:	US
Telephone Number	:	404-351-6662
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 COLLIER RD NW
Second Line	:	SUITE 4060
City	:	ATLANTA
State	:	GA
Zip	:	30309-1710
Country	:	US
Telephone Number	:	404-351-6662
Fax Number	:

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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