Healthcare Provider Details

I. General information

NPI: 1982913802
Provider Name (Legal Business Name): DAVID F HARRIS , MTS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 CHESHIRE BRIDGE RD NE
ATLANTA GA
30324-4234
US

IV. Provider business mailing address

2215 CHESHIRE BRIDGE RD NE
ATLANTA GA
30324-4234
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-7171
  • Fax: 404-634-0849
Mailing address:
  • Phone: 404-816-7171
  • Fax: 404-634-0849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC002354
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: