Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT011317 | GA |
NPI | 1043640287 |
---|---|
Provider Name | Carlyn N Harris |
First Address | Roswell, GA 30076-4943 |
Second Address | Roswell, GA 30076-4943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2013 |
Last Update Date | 26/11/2013 |