Provider Demographics
NPI:1518099910
Name:HARRISON, NZINGA AJABU (MD)
Entity Type:Individual
Prefix:DR
First Name:NZINGA
Middle Name:AJABU
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2810
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-2810
Mailing Address - Country:US
Mailing Address - Phone:828-989-8686
Mailing Address - Fax:
Practice Address - Street 1:123 PROFESSIONAL PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5516
Practice Address - Country:US
Practice Address - Phone:704-799-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18029562084P0800X
OH35.1405022084P0800X
GA0542022084P0800X
NC2019-022552084P0800X
WAMD610988102084P0800X
FLME1533712084P0800X
TXT43822084P0800X
CAC554922084P0800X
DEC1-00246832084P0800X
IAMD-502522084P0800X
PAMD4742092084P0800X
KY530122084P0800X
LA3247782084P0800X
MA2835112084P0800X
NJ25MA106756002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI45159Medicare UPIN
GA26BDKFMMedicare ID - Type Unspecified