Provider Demographics
NPI:1295785103
Name:HARRIS, ADAM W (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:W
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1308
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-1308
Mailing Address - Country:US
Mailing Address - Phone:912-756-4117
Mailing Address - Fax:912-756-4127
Practice Address - Street 1:2459 HWY 17
Practice Address - Street 2:STE C
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324
Practice Address - Country:US
Practice Address - Phone:912-756-4117
Practice Address - Fax:912-756-4127
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0507682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA050768OtherLICENSE
GAI36339Medicare UPIN