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General NPI Number Information
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NPI Number | 1588555619
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Entity Type | Individual
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Provider Name | ELIZA GRACE HARRIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 2711 IRVIN WAY STE 205
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City | DECATUR
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State | GA
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Zip | 30030-1724
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Country | US
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Telephone | 404-355-1446
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Fax | 404-328-0226
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Provider Business Mailing Address
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Address Line | 744 TWIN OAKS DR APT 1
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City | DECATUR
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State | GA
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Zip | 30030-4058
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Country | US
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Telephone | 706-969-9729
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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 | 13197
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License Number State | GA
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