Healthcare Provider Details

I. General information

NPI: 1376350769
Provider Name (Legal Business Name): HARRISON HOLISTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 INDIAN WOOD CIR SE
MABLETON GA
30126-2964
US

IV. Provider business mailing address

6115 INDIAN WOOD CIR SE
MABLETON GA
30126-2964
US

V. Phone/Fax

Practice location:
  • Phone: 617-417-9275
  • Fax:
Mailing address:
  • Phone: 617-417-9275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TANYA RENEE HARRISON
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP-BC
Phone: 617-417-9275