MEDICARE: YOLANDA HARRIS

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	253Z00000X	In Home Supportive Care Agency	PHCP043064	GA

General Provider Information

NPI Number	:	1891675104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA HARRIS

Provider Business Mailing Address
First Line	:	2605 CORNWALL DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6875
Country	:	US
Telephone Number	:	678-544-9234
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 CORNWALL DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6875
Country	:	US
Telephone Number	:	678-544-9234
Fax Number	:

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

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	10/24/2025

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Directions to “ YOLANDA HARRIS ” Practice Location

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