MEDICARE: PAUL L HARVEY MD

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	207R00000X	Internal Medicine Physician	036647	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053410357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL L HARVEY MD

Provider Business Mailing Address
First Line	:	483 UPPER RIVERDALE RD SW STE G
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2584
Country	:	US
Telephone Number	:	770-996-9400
Fax Number	:	770-991-2918

Provider Business Practice Location Address
First Line	:	483 UPPER RIVERDALE RD SW STE G
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2584
Country	:	US
Telephone Number	:	770-996-9400
Fax Number	:	770-991-2918

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/12/2020

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