MEDICARE: MARY ALISHA HARRIS CPNP

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
1	363LP0200X	Pediatric Nurse Practitioner	RN173289	GA

General Provider Information

NPI Number	:	1356697387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ALISHA HARRIS CPNP

Provider Business Mailing Address
First Line	:	1960 STONEY POINT RD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-6751
Country	:	US
Telephone Number	:	770-402-2558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 JOHNSON FERRY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1605
Country	:	US
Telephone Number	:	404-785-2984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	04/11/2026

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