Provider Demographics
NPI:1427229632
Name:HARRIS, COREY DEWAYNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:DEWAYNE
Last Name:HARRIS
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 1:335 UPPER RIVERDALE RD
Mailing Address - Street 2:SUITE B10
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1099
Mailing Address - Country:US
Mailing Address - Phone:770-907-5743
Mailing Address - Fax:770-907-5746
Practice Address - Street 1:335 UPPER RIVERDALE RD
Practice Address - Street 2:SUITE B10
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1099
Practice Address - Country:US
Practice Address - Phone:770-907-5743
Practice Address - Fax:770-907-5746
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist