Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 13094 | TN |
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN271274 | GA |
NPI | 1063696185 |
---|---|
Provider Name | Marilyn Wyatt Harris |
First Address | Savannah, GA 31401-6913 |
Second Address | Savannah, GA 31401-6913 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2007 |
Last Update Date | 17/07/2019 |