Provider Demographics
NPI:1417027277
Name:HARRIS, SHIRLEY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-0910
Mailing Address - Country:US
Mailing Address - Phone:404-294-8180
Mailing Address - Fax:404-294-8188
Practice Address - Street 1:3292 MOUNTAIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1102
Practice Address - Country:US
Practice Address - Phone:404-294-8180
Practice Address - Fax:404-294-8188
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041305207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00715371BMedicaid
GA041305OtherSTATE LICENSE
GA041305OtherSTATE LICENSE
F83468Medicare UPIN
10BBBZDMedicare ID - Type Unspecified