Healthcare Provider Details

I. General information

NPI: 1205629078
Provider Name (Legal Business Name): LUD DENOSE-HARRIS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RBC DR
RINGGOLD GA
30736-2787
US

IV. Provider business mailing address

971 KORA DR SW
MARIETTA GA
30064-0005
US

V. Phone/Fax

Practice location:
  • Phone: 404-937-0561
  • Fax:
Mailing address:
  • Phone: 404-937-0561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN154948
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP154948
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN154948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: