Provider Demographics
NPI:1275784332
Name:HARRIS, PATRICIA R
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:R
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS/PMS
Mailing Address - Street 1:3102 ASHFORD GABLES DR
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6760
Mailing Address - Country:US
Mailing Address - Phone:678-580-5264
Mailing Address - Fax:
Practice Address - Street 1:4780 ASHFORD DUNWOODY RD
Practice Address - Street 2:SUITE A-266
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5564
Practice Address - Country:US
Practice Address - Phone:404-228-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN084164364SG0600X
GARN084164 CNS/PMH364SP0813X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0813XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Geropsychiatric
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology