Healthcare Provider Details

I. General information

NPI: 1326471913
Provider Name (Legal Business Name): VABAH HARRIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VABAH KOTEE

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 HIGHWAY 54 W STE 2200
FAYETTEVILLE GA
30214-2110
US

IV. Provider business mailing address

1267 HIGHWAY 54 W STE 2200
FAYETTEVILLE GA
30214-2110
US

V. Phone/Fax

Practice location:
  • Phone: 770-716-0051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9567
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9567
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: