Corliss La-Shunuette Austin-Harris, D.P.M., M.S.
Individual provider Active NPI Podiatrist · Stone Mountain, GA
NPI 1285656181 · NPPES record last updated Feb 16, 2012
Key facts
- NPI
- 1285656181
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- POD000689 (GA)
- Practice address
- 770 Village Square Dr
Stone Mountain, GA 30083-3380 - Phone
- (404) 298-8998
- Fax
- (404) 298-7658
- NPI assigned
- Jul 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 15
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Kent State University College of Podiatric Medicine, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Medcura Health, Inc
Practice addresses (Care Compare)
1760 Candler Rd
Decatur, GA 30032-3254
Phone (404) 298-7658
770 Village Square Dr
Stone Mountain, GA 30083-3215
770 Village Square Dr
Stone Mountain, GA 30083-3380
Phone (404) 298-7658
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070326000411 | GA | Practitioner - Podiatry | 4587768866 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 689 | GA | MD | Case Manager/Care Coordinator |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medcura Health, Inc. | Current |
Accepting new patients | |
| Medcura Health, Inc. | Current | Accepting new patients | |
| Medcura Health, Inc. | Current |
Accepting new patients | |
| Medcura Health, Inc. | Past | Accepting new patients | |
| Medcura Health, Inc. | Past | Accepting new patients |
Locations
80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370
1706 Candler Rd
Decatur, GA 30032
5582 Memorial Dr
Stone Mountain, GA 30083
Phone (404) 513-9965
770 Village Square Dr
Stone Mtn, GA 30083
Phone (404) 298-7658
Interoperability endpoints
- corliss.austin.harris.1@9679.direct.athenahealth.com
- corliss.austinharris@oakhurst.gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | POD000689 | GA | Yes |
Addresses
Primary practice location
770 Village Square Dr
Stone Mountain, GA 30083-3380
Mailing address
770 Village Square Dr
Stone Mountain, GA 30083-3380
Phone (404) 298-8998
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480023572 | Other | RAILROAD MEDICARE | |
| 000536357B | Medicaid | GA |
Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.