Healthcare Provider Details

I. General information

NPI: 1336948702
Provider Name (Legal Business Name): SADIE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 MERCHANTS SQ
DALLAS GA
30132-5029
US

IV. Provider business mailing address

184 OLD GRIFFIN RD
DALLAS GA
30157-1109
US

V. Phone/Fax

Practice location:
  • Phone: 470-391-2300
  • Fax:
Mailing address:
  • Phone: 678-510-8796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-341354
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: