Healthcare Provider Details

I. General information

NPI: 1316812472
Provider Name (Legal Business Name): SYLVIA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 INTERSTATE NORTH CIR SE STE 200
ATLANTA GA
30339-2384
US

IV. Provider business mailing address

204 MAHNAZ DR SW
ATLANTA GA
30331-6022
US

V. Phone/Fax

Practice location:
  • Phone: 404-956-5911
  • Fax:
Mailing address:
  • Phone: 404-956-5911
  • Fax: 404-956-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberOG3ZUTZTND
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: