Healthcare Provider Details

I. General information

NPI: 1619685344
Provider Name (Legal Business Name): KAMESHA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 GARDEN HILLS LOOP
RICHMOND HILL GA
31324-5768
US

IV. Provider business mailing address

550 GARDEN HILLS LOOP
RICHMOND HILL GA
31324-5768
US

V. Phone/Fax

Practice location:
  • Phone: 704-231-9481
  • Fax:
Mailing address:
  • Phone: 704-231-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: