Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 155058 | GA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 155058 | GA |
NPI | 1003244021 |
---|---|
Provider Name | Mary Allene Harrison |
First Address | Atlanta, GA 30309-1316 |
Second Address | Atlanta, GA 30309-1316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2013 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003150976A | (05) | GA |