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4275 Johns Creek Pkwy Suite C Suwanee GA 30024-6038 | |
| (770) 454-4685 | |
| (770) 454-4690 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4275 Johns Creek Pkwy, Suwanee, Georgia |
| Authorized Official Name and Position | Mark I Harris (MEDICAL DOCTOR) |
| Authorized Official Contact | 7704544685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4275 Johns Creek Pkwy Suite C Suwanee GA 30024-6038 Ph: (770) 454-4685 | 4275 Johns Creek Pkwy Suite C Suwanee GA 30024-6038 Ph: (770) 454-4685 |
| NPI Number | 1053427542 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 11/01/2007 |
| Medicare PECOS PAC ID | 3476548058 |
|---|---|
| Medicare Enrollment ID | O20040415000214 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053427542 | NPI | - | NPPES |
| 00371115D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 30084 (Georgia) | Primary |
| Provider Name | Robert C Waldrop |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1043372444 PECOS PAC ID: 7618861030 Enrollment ID: I20040209000386 |
| Provider Name | Mark I Harris |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649262577 PECOS PAC ID: 8022024934 Enrollment ID: I20060302000153 |
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