Provider Demographics
NPI:1689620825
Name:HARRISON, CHARLES E JR (MD,MACP)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:HARRISON
Suffix:JR
Gender:M
Credentials:MD,MACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 DOWNWOOD CIRCLE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:404-351-0205
Mailing Address - Fax:404-350-9823
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-355-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D40079Medicare UPIN
GAD40079Medicare UPIN