Provider Demographics
NPI:1154849594
Name:HARRIS-WYATT, GEORGETTA
Entity Type:Individual
Prefix:
First Name:GEORGETTA
Middle Name:
Last Name:HARRIS-WYATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GEORGETTA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2636 NASHBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-4849
Mailing Address - Country:US
Mailing Address - Phone:615-854-0559
Mailing Address - Fax:
Practice Address - Street 1:2400 RUSSELLVILLE RD
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8095
Practice Address - Country:US
Practice Address - Phone:270-889-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program