Healthcare Provider Details

I. General information

NPI: 1043721723
Provider Name (Legal Business Name): ROCHELLE LAVONNE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 W HIGHLAND AVE
ALBANY GA
31701-2778
US

IV. Provider business mailing address

3816 MAYFAIR LN APT A
ALBANY GA
31721-6547
US

V. Phone/Fax

Practice location:
  • Phone: 404-447-8659
  • Fax:
Mailing address:
  • Phone: 404-447-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: