Basic Information
Provider Information
NPI: 1033556725
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARVEY
FirstName: ERNESTINE
MiddleName:  
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NameSuffix:  
Credential:  
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Mailing Information
Address1: 3120 SEVEN PINES CT
Address2:  
City: ATLANTA
State: GA
PostalCode: 303395848
CountryCode: US
TelephoneNumber: 7703555617
FaxNumber:  
Practice Location
Address1: 3120 SEVEN PINES CT
Address2:  
City: ATLANTA
State: GA
PostalCode: 303395848
CountryCode: US
TelephoneNumber: 7703555617
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2013
LastUpdateDate: 06/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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