Provider Demographics
NPI:1861008922
Name:HARRIS, BEN LEE (MED)
Entity Type:Individual
Prefix:MR
First Name:BEN
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-3005
Mailing Address - Country:US
Mailing Address - Phone:678-481-4374
Mailing Address - Fax:
Practice Address - Street 1:140 E MARIETTA ST STE 301
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3002
Practice Address - Country:US
Practice Address - Phone:770-213-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-20-44630103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst