Healthcare Provider Details

I. General information

NPI: 1386894806
Provider Name (Legal Business Name): STEPHEN B HARRIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTURY PL NE SUITE 200
ATLANTA GA
30345-4307
US

IV. Provider business mailing address

1900 CENTURY PL NE SUITE 200
ATLANTA GA
30345-4307
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-4954
  • Fax: 404-321-1928
Mailing address:
  • Phone: 404-321-4954
  • Fax: 404-321-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW000767
License Number StateGA

VIII. Authorized Official

Name: STEPHEN B HARRIS
Title or Position: PRESIDENT
Credential: LCSW
Phone: 404-321-4954