Provider Demographics
NPI:1710027883
Name:HARRIS, SHERYL LEVETTE
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:LEVETTE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CARROLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5445
Mailing Address - Country:US
Mailing Address - Phone:770-716-7990
Mailing Address - Fax:770-716-7955
Practice Address - Street 1:140 CARROLLWOOD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-5445
Practice Address - Country:US
Practice Address - Phone:770-716-7990
Practice Address - Fax:770-716-7955
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000977501EMedicaid