Healthcare Provider Details

I. General information

NPI: 1700813581
Provider Name (Legal Business Name): JANNA HARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/03/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 PEACHTREE DUNWOODY RD NE SUITE 200
ATLANTA GA
30342-1764
US

IV. Provider business mailing address

1838 AMERICAN WAY
LAWRENCEVILLE GA
30043-6611
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-6104
  • Fax: 404-257-1808
Mailing address:
  • Phone: 770-995-7622
  • Fax: 770-995-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT830
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112078
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5762
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010216
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9112078
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062343
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: