Provider Demographics
NPI:1316012545
Name:HARRIS, JOHN KEITH (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KEITH
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:7350 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6604
Practice Address - Country:US
Practice Address - Phone:678-473-1081
Practice Address - Fax:678-473-1082
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT7834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4895Medicare ID - Type Unspecified
GA65BBDXXMedicare PIN
GAGRP7336Medicare ID - Type Unspecified
GA65BBDXJMedicare PIN