Healthcare Provider Details

I. General information

NPI: 1023055779
Provider Name (Legal Business Name): WAYNE B HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

2111 MOUNTAIN LN
STONE MOUNTAIN GA
30087-1035
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5000
  • Fax:
Mailing address:
  • Phone: 770-908-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number034150
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: