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General NPI Number Information
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NPI Number | 1306144662
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Entity Type | Individual
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Provider Name | ANGELINE HYATT HARRIS
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Gender | Female
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 3055 HIGHWAY 34 E
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City | NEWNAN
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State | GA
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Zip | 30265-2179
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Country | US
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Telephone | 770-252-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2169 POPLAR RD
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City | NEWNAN
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State | GA
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Zip | 30265-1628
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Country | US
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Telephone | 770-253-5229
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 12401
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License Number State | GA
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