Individual
MR. STACEY HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 HICKORY CIR, CARROLLTON, GA 30116-8692
(678) 601-3504
Mailing address
55 HICKORY CIR, CARROLLTON, GA 30116-8692
(678) 601-3504
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
022-01-022-1
GA
Other
Enumeration date
03/17/2010
Last updated
06/22/2011
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