Healthcare Provider Details

I. General information

NPI: 1295785103
Provider Name (Legal Business Name): ADAM W HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 HWY 17 STE C
RICHMOND HILL GA
31324
US

IV. Provider business mailing address

PO BOX 1308
RICHMOND HILL GA
31324-1308
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-4117
  • Fax: 912-756-4127
Mailing address:
  • Phone: 912-756-4117
  • Fax: 912-756-4127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number050768
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: