Healthcare Provider Details

I. General information

NPI: 1255104451
Provider Name (Legal Business Name): STEVEN RONALD HARLAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

1130 N JAMESTOWN RD APT 508
DECATUR GA
30033-7121
US

V. Phone/Fax

Practice location:
  • Phone: 614-817-9856
  • Fax:
Mailing address:
  • Phone: 614-817-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberPOD-14
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD-14
License Number StateGU
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-14
License Number StateGU
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD-14
License Number StateGU
# 5
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-14
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: