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DR. CORLISS LA-SHUNUETTE AUSTIN-HARRIS D.P.M., M.S.
>> Podiatrist >> Podiatric Medicine & Surgery Service ProvidersRegistrant NPI Number: 1285656181
Individual Registrant:DR. CORLISS LA-SHUNUETTE AUSTIN-HARRIS D.P.M., M.S.
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
770 VILLAGE SQUARE DR STONE MOUNTAIN, GA 30083-3380 US
Tel: 404-298-8998 Fax: 404-298-7658
Tel: 404-298-8998 Fax: 404-298-7658
Contact information for business:
770 VILLAGE SQUARE DR STONE MOUNTAIN, GA 30083-3380 US
Tel: 404-298-8998 Fax: 404-298-7658
Tel: 404-298-8998 Fax: 404-298-7658
Registration Information:
NPI: 1285656181
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 213E00000X | Podiatric Medicine & Surgery Service Providers Podiatrist | GA | POD000689 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 000536357B | GA | 05 | |
| RAILROAD MEDICARE | 480023572 | 01 |
