Provider Demographics
NPI:1225036718
Name:HARRIS, ALICE G (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:G
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2293
Mailing Address - Country:US
Mailing Address - Phone:706-548-6068
Mailing Address - Fax:706-354-1218
Practice Address - Street 1:700 SUNSET DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2293
Practice Address - Country:US
Practice Address - Phone:706-548-6068
Practice Address - Fax:706-354-1218
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine