Provider Demographics
NPI:1609857804
Name:HARMON, MARCIA (CNM)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2750 OWEN'S DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094
Mailing Address - Country:US
Mailing Address - Phone:678-413-4644
Mailing Address - Fax:678-413-4624
Practice Address - Street 1:140 EAGLE SPRING CT
Practice Address - Street 2:STE B
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:678-413-4644
Practice Address - Fax:678-413-4624
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN079076367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00412992BMedicaid