Provider Demographics
NPI:1225643257
Name:HARRIS, MELINDA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10809 LEES CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7870
Mailing Address - Country:US
Mailing Address - Phone:470-729-0166
Mailing Address - Fax:770-703-5114
Practice Address - Street 1:101 BECKETT LN STE 505
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7160
Practice Address - Country:US
Practice Address - Phone:470-729-0166
Practice Address - Fax:770-703-5114
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259311163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse