Healthcare Provider Details

I. General information

NPI: 1033570817
Provider Name (Legal Business Name): CALVIN HARVEY JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 GWINNETT DR
LAWRENCEVILLE GA
30046-8444
US

IV. Provider business mailing address

4305 GAVIRA CT
CUMMING GA
30040-0456
US

V. Phone/Fax

Practice location:
  • Phone: 678-209-2394
  • Fax: 678-212-6343
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN232563
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: