1538302427 NPI number — MRS. PAMELYN EVETTE HARRIS LAPC

Table of content: MRS. PAMELYN EVETTE HARRIS LAPC (NPI 1538302427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538302427 NPI number — MRS. PAMELYN EVETTE HARRIS LAPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
PAMELYN
Provider Middle Name:
EVETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LAPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538302427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 KYNDAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30228-4862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-897-2580
Provider Business Mailing Address Fax Number:
770-897-2580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
853 BATTLECREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-478-1099
Provider Business Practice Location Address Fax Number:
770-478-8722
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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