Provider Demographics
NPI:1801321104
Name:PHARRIS, KEVIN ROY (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROY
Last Name:PHARRIS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2675 PACES FERRY RD SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4099
Mailing Address - Country:US
Mailing Address - Phone:785-046-4006
Mailing Address - Fax:770-626-3791
Practice Address - Street 1:4400 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2729
Practice Address - Country:US
Practice Address - Phone:404-814-9199
Practice Address - Fax:404-869-8118
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA86112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program