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General NPI Number Information
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NPI Number | 1831522671
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Entity Type | Individual
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Provider Name | AFFINITI HARRIS-MORDECAI
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Gender | Female
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 419 E CROSSVILLE RD STE 207
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City | ROSWELL
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State | GA
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Zip | 30075-3080
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Country | US
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Telephone | 770-545-6443
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Fax |
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Provider Business Mailing Address
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Address Line | 8920 EVES RD UNIT 769491
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City | ROSWELL
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State | GA
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Zip | 30076-0131
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Country | US
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Telephone | 770-545-6443
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | CSW005388
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License Number State | GA
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