Provider Demographics
NPI:1003452384
Name:HARRIS, ROLAND KAREEM
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:KAREEM
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 1:4544 QUEEN ANNE CT SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1432
Mailing Address - Country:US
Mailing Address - Phone:205-382-6710
Mailing Address - Fax:
Practice Address - Street 1:4544 QUEEN ANNE CT SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-1432
Practice Address - Country:US
Practice Address - Phone:205-382-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)