Provider Demographics
NPI:1497476824
Name:OWENS, HARRIETT SALINA
Entity Type:Individual
Prefix:MS
First Name:HARRIETT
Middle Name:SALINA
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 JONESBORO RD STE 240
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1090
Mailing Address - Country:US
Mailing Address - Phone:404-720-6107
Mailing Address - Fax:
Practice Address - Street 1:4252 RIDGELAND TER
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3029
Practice Address - Country:US
Practice Address - Phone:404-798-1049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057797673172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver