1760750137 NPI number — KAISER PERMANENTE

Table of content: CAWANNA HARRIS MS, LPC (NPI 1760900021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760750137 NPI number — KAISER PERMANENTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER PERMANENTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760750137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 PIEDMONT RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2142 W BROAD ST
Provider Second Line Business Practice Location Address:
BLDG 200
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-583-5000
Provider Business Practice Location Address Fax Number:
706-583-5002
Provider Enumeration Date:
12/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
FARMER
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF LABORATORY SERVICES
Authorized Official Telephone Number:
404-309-9314

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  11D2032281 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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