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NPI Code Detail

MEDICARE: AMY K HARRIS N.P

MEDICARE:   AMY K HARRIS  N.P
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner0103714TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11750514410OTHERTNGROUP NPI

General Provider Information

NPI Number : 1124034541
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY K HARRIS N.P
Provider Business Mailing Address
First Line : PO BOX 405827
Second Line :
City : ATLANTA
State : GA
Zip : 30384-5800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1109 E REELFOOT AVE STE F
Second Line :
City : UNION CITY
State : TN
Zip : 38261-5867
Country : US
Telephone Number : 731-884-1412
Fax Number : 731-884-1720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 10/25/2016

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