Healthcare Provider Details

I. General information

NPI: 1710558366
Provider Name (Legal Business Name): ALEXIS HARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 PEACHTREE ST NE STE 570
ATLANTA GA
30308-1244
US

IV. Provider business mailing address

5740 BUFFINGTON RD APT 1524
ATLANTA GA
30349-3863
US

V. Phone/Fax

Practice location:
  • Phone: 877-733-7033
  • Fax:
Mailing address:
  • Phone: 813-483-9418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: