MEDICARE: STEPHEN B. HARRIS L.C.S.W.

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	1041C0700X	Clinical Social Worker	CSW000767	GA

General Provider Information

NPI Number	:	1669672598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN B. HARRIS L.C.S.W.

Provider Business Mailing Address
First Line	:	1900 CENTURY PLACE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-4302
Country	:	US
Telephone Number	:	404-321-4954
Fax Number	:	404-321-1928

Provider Business Practice Location Address
First Line	:	1900 CENTURY PLACE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-4302
Country	:	US
Telephone Number	:	404-321-4954
Fax Number	:	404-321-1928

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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