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General NPI Number Information
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NPI Number | 1215148382
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Entity Type | Individual
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Provider Name | MARY HARLOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7694
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Country | US
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Telephone | 678-442-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 2285 HARBIN OAKS DR
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City | DACULA
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State | GA
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Zip | 30019-2389
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3834
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License Number State | GA
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