Provider Demographics
NPI:1003167669
Name:HARRIS, AYANNA TENAY (LPN)
Entity Type:Individual
Prefix:
First Name:AYANNA
Middle Name:TENAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 CARRIAGE TRACE CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4661
Mailing Address - Country:US
Mailing Address - Phone:770-484-2600
Mailing Address - Fax:
Practice Address - Street 1:2277 STONE MOUNTAIN LITHONIA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5252
Practice Address - Country:US
Practice Address - Phone:770-484-2600
Practice Address - Fax:770-484-0155
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN067861164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse