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General NPI Number Information
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NPI Number | 1114004959
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Entity Type | Individual
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Provider Name | DR. EDDIE HARRIS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 3890 REDWINE RD SW SUITE 212
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City | ATLANTA
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State | GA
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Zip | 30331-5582
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Country | US
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Telephone | 404-349-1115
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Fax | 404-349-0141
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Provider Business Mailing Address
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Address Line | 3890 REDWINE RD SW SUITE 212
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City | ATLANTA
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State | GA
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Zip | 30331-5582
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Country | US
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Telephone | 404-349-1115
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Fax | 404-349-0141
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 053235
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License Number State | GA
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