Healthcare Provider Details

I. General information

NPI: 1497476824
Provider Name (Legal Business Name): MS. HARRIETT SALINA OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE R
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

8735 DUNWOODY PL STE R
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 404-301-8124
  • Fax:
Mailing address:
  • Phone: 404-301-8124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number057797673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: