Provider Demographics
NPI:1053410357
Name:HARVEY, PAUL L (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 UPPER RIVERDALE RD SW STE G
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2584
Mailing Address - Country:US
Mailing Address - Phone:770-996-9400
Mailing Address - Fax:770-991-2918
Practice Address - Street 1:483 UPPER RIVERDALE RD SW STE G
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2584
Practice Address - Country:US
Practice Address - Phone:770-996-9400
Practice Address - Fax:770-991-2918
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00897949AMedicaid
H33651Medicare UPIN
11BDSVCMedicare ID - Type Unspecified