Provider Demographics
NPI:1659355584
Name:HARLEY, BRIAN S (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:HARLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11680 GREAT OAKS WAY STE 530
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-2460
Mailing Address - Country:US
Mailing Address - Phone:770-755-5749
Mailing Address - Fax:770-755-5741
Practice Address - Street 1:3400 OLD MILTON PKWY BLDG A
Practice Address - Street 2:STE. 500
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-667-4410
Practice Address - Fax:770-667-4411
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001016213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I489517Medicare PIN
GA202I480230Medicare PIN
V04990Medicare UPIN