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DR. CORLISS LA-SHUNUETTE AUSTIN-HARRIS D.P.M., M.S.

>> Podiatrist >> Podiatric Medicine & Surgery Service Providers

Registrant NPI Number: 1285656181

Individual Registrant:
DR. CORLISS LA-SHUNUETTE AUSTIN-HARRIS D.P.M., M.S.
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

Contact information for business:
770 VILLAGE SQUARE DR  STONE MOUNTAIN, GA 30083-3380 US
Tel: 404-298-8998  Fax: 404-298-7658

Registration Information:
NPI: 1285656181
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y213E00000XPodiatric Medicine & Surgery Service Providers
Podiatrist
GAPOD000689

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
000536357BGA05
RAILROAD MEDICARE48002357201




HEALTH CARE JOBS GA - Page 1



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