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NPI Code Detail

MEDICARE: YVONNE LONG HARRIS FNP

MEDICARE: YVONNE LONG HARRIS FNP
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
1363LF0000XFamily Nurse PractitionerRN049658GA

General Provider Information

NPI Number : 1669558425
Entity Type Code : Individual
Provider Name (Legal Business Name) : YVONNE LONG HARRIS FNP
Provider Business Mailing Address
First Line : 2429 MARTIN LUTHER KING JR DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30311-1713
Country : US
Telephone Number : 404-691-9580
Fax Number :
Provider Business Practice Location Address
First Line : 2429 MARTIN LUTHER KING JR DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30311-1713
Country : US
Telephone Number : 404-691-9580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 08/23/2021

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