Healthcare Provider Details

I. General information

NPI: 1447730551
Provider Name (Legal Business Name): LAYCEE SUMNER HARRIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 N 5TH STREET EXT STE A
CORDELE GA
31015-3753
US

IV. Provider business mailing address

1114 GA HIGHWAY 96
WARNER ROBINS GA
31088
US

V. Phone/Fax

Practice location:
  • Phone: 229-417-9105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN715611
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number096281
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: