Provider Demographics
NPI:1316595002
Name:GOUDISS, HARRISON L (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:L
Last Name:GOUDISS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 ROSWELL RD
Mailing Address - Street 2:SUITE W
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1978
Mailing Address - Country:US
Mailing Address - Phone:404-477-5555
Mailing Address - Fax:404-477-5556
Practice Address - Street 1:5290 ROSWELL RD
Practice Address - Street 2:SUITE W
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1978
Practice Address - Country:US
Practice Address - Phone:404-477-5555
Practice Address - Fax:404-477-5556
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist