MEDICARE: CAMILLE HARRIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist	AT002296	GA

General Provider Information

NPI Number	:	1003208679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE HARRIS

Provider Business Mailing Address
First Line	:	125 DECATUR ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 DECATUR ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-3201
Country	:	US
Telephone Number	:	404-413-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	02/19/2015

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Directions to “ CAMILLE HARRIS ” Practice Location

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