Provider Demographics
NPI:1194447359
Name:HARRIS, ADRIAN DWAYNE
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:DWAYNE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4658 PRESIDENTIAL PKWY # 1137
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-8708
Mailing Address - Country:US
Mailing Address - Phone:478-841-9411
Mailing Address - Fax:
Practice Address - Street 1:4550 DORSET DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-8231
Practice Address - Country:US
Practice Address - Phone:786-930-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver