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NPI Code Detail

MEDICARE: MR. JIM KEITH HARRIS L.C.S.W.

MEDICARE: MR. JIM KEITH 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
11041C0700XClinical Social WorkerCSW001491GA

General Provider Information

NPI Number : 1962538785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JIM KEITH HARRIS L.C.S.W.
Provider Business Mailing Address
First Line : 623 WENDAN DR
Second Line :
City : DECATUR
State : GA
Zip : 30033-5550
Country : US
Telephone Number : 770-242-2340
Fax Number :
Provider Business Practice Location Address
First Line : 1834 CLAIRMONT RD
Second Line :
City : DECATUR
State : GA
Zip : 30033-3405
Country : US
Telephone Number : 770-242-2340
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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