Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN307869 | GA |
NPI | 1225706401 |
---|---|
Provider Name | Callie Harris |
First Address | Macon, GA 31210-5381 |
Second Address | Macon, GA 31201-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2021 |
Last Update Date | 09/02/2022 |