Healthcare Provider Details

I. General information

NPI: 1386509818
Provider Name (Legal Business Name): CYNTHIA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5947 LANDERS LOOP
FAIRBURN GA
30213-4741
US

IV. Provider business mailing address

5947 LANDERS LOOP
FAIRBURN GA
30213-4741
US

V. Phone/Fax

Practice location:
  • Phone: 919-323-9679
  • Fax:
Mailing address:
  • Phone: 919-323-9679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN252350
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: