Healthcare Provider Details

I. General information

NPI: 1386322832
Provider Name (Legal Business Name): JADA HARRISON APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 FLAT SHOALS RD SE
CONYERS GA
30013-1809
US

IV. Provider business mailing address

224 LONG NEEDLE DR
MCDONOUGH GA
30252-1650
US

V. Phone/Fax

Practice location:
  • Phone: 404-664-3873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberAPRN280658
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: