Healthcare Provider Details

I. General information

NPI: 1831550623
Provider Name (Legal Business Name): IMANI HARRIOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 HOSPITAL PKWY
DULUTH GA
30097-1549
US

IV. Provider business mailing address

6335 HOSPITAL PKWY STE 304
DULUTH GA
30097-5712
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8311
  • Fax:
Mailing address:
  • Phone: 404-778-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN185858
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2304704
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11000895
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209027728
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: