Healthcare Provider Details

I. General information

NPI: 1275784332
Provider Name (Legal Business Name): PATRICIA R HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA R. HARRIS CNS/PMS

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 ASHFORD DUNWOODY RD SUITE A-266
ATLANTA GA
30338-5564
US

IV. Provider business mailing address

3102 ASHFORD GABLES DR
DUNWOODY GA
30338-6760
US

V. Phone/Fax

Practice location:
  • Phone: 404-228-9661
  • Fax:
Mailing address:
  • Phone: 678-580-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberRN084164
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN084164 CNS/PMH
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: