Provider Demographics
NPI:1386894806
Name:STEPHEN B HARRIS
Entity type:Organization
Organization Name:STEPHEN B HARRIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-321-4954
Mailing Address - Street 1:1900 CENTURY PL NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-4307
Mailing Address - Country:US
Mailing Address - Phone:404-321-4954
Mailing Address - Fax:404-321-1928
Practice Address - Street 1:1900 CENTURY PL NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-4307
Practice Address - Country:US
Practice Address - Phone:404-321-4954
Practice Address - Fax:404-321-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0007671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6848OtherMEDICARE
GAGRP6848OtherMEDICARE
GAR13007Medicare UPIN