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General NPI Number Information
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NPI Number | 1508450156
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Entity Type | Individual
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Provider Name | LINDA MAE HARRIS LPN
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Gender | Female
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 311 WHITE INGRAM PKWY
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City | DALLAS
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State | GA
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Zip | 30132-0969
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Country | US
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Telephone | 678-363-7447
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Fax | 678-363-7787
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Provider Business Mailing Address
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Address Line | 713 CREEKRIDGE CT
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City | TEMPLE
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State | GA
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Zip | 30179-5442
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Country | US
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Telephone | 857-544-3641
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN082024
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License Number State | GA
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