Provider Demographics
NPI:1851868624
Name:HARRIS-HACKETT, SARITA NIKKI
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:NIKKI
Last Name:HARRIS-HACKETT
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 1:6285 S SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-3951
Mailing Address - Country:US
Mailing Address - Phone:404-789-1569
Mailing Address - Fax:
Practice Address - Street 1:1102 THORNTON RD STE C
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2688
Practice Address - Country:US
Practice Address - Phone:770-927-7341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine