Provider Demographics
NPI:1043721723
Name:HARRIS, ROCHELLE LAVONNE
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LAVONNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 MAYFAIR LN APT A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-6547
Mailing Address - Country:US
Mailing Address - Phone:404-447-8659
Mailing Address - Fax:
Practice Address - Street 1:828 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2778
Practice Address - Country:US
Practice Address - Phone:404-447-8659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1744P3200XOther1744P3200X