Healthcare Provider Details

I. General information

NPI: 1710616784
Provider Name (Legal Business Name): JOANNE B HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 05/20/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 BUENA VISTA RD
COLUMBUS GA
31907-5164
US

IV. Provider business mailing address

204 DUPONT CT
MCDONOUGH GA
30252-5844
US

V. Phone/Fax

Practice location:
  • Phone: 478-918-4040
  • Fax:
Mailing address:
  • Phone: 770-285-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN25421
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN25421
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: