Provider Demographics
NPI:1538334925
Name:HARRY PORTER JR. M.D.
Entity type:Organization
Organization Name:HARRY PORTER JR. M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-778-8999
Mailing Address - Street 1:2625 CUMBERLAND PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3943
Mailing Address - Country:US
Mailing Address - Phone:770-435-6004
Mailing Address - Fax:770-435-6005
Practice Address - Street 1:2625 CUMBERLAND PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3943
Practice Address - Country:US
Practice Address - Phone:770-435-6004
Practice Address - Fax:770-435-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112184170AMedicare PIN