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NPI Code Detail

MEDICARE: DOMINIQUE HARRY

MEDICARE: DOMINIQUE HARRY
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
11041C0700XClinical Social WorkerCSW009962GA

General Provider Information

NPI Number : 1821853250
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE HARRY
Provider Business Mailing Address
First Line : 6425 POWERS FERRY RD STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30339-2908
Country : US
Telephone Number : 770-376-7381
Fax Number :
Provider Business Practice Location Address
First Line : 6425 POWERS FERRY RD STE 300
Second Line :
City : ATLANTA
State : GA
Zip : 30339-2908
Country : US
Telephone Number : 866-841-1906
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2024
Last Update Date : 04/27/2026

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Directions to “ DOMINIQUE HARRY ” Practice Location

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