Healthcare Provider Details

I. General information

NPI: 1366874927
Provider Name (Legal Business Name): MAISHA NILANJA HARVEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-4022
  • Fax:
Mailing address:
  • Phone: 770-732-4022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP175742
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN175742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: