Healthcare Provider Details

I. General information

NPI: 1730828294
Provider Name (Legal Business Name): ANTONIA MAISHA HARRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 BOB ARNOLD BLVD
LITHIA SPRINGS GA
30122-3258
US

IV. Provider business mailing address

1578 HALBROOKE PL SW
MARIETTA GA
30008-3527
US

V. Phone/Fax

Practice location:
  • Phone: 404-474-7596
  • Fax:
Mailing address:
  • Phone: 706-761-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN276975
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN276975
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: