Provider Demographics
NPI:1992380356
Name:HARRIS, SHAWANDA K
Entity Type:Individual
Prefix:
First Name:SHAWANDA
Middle Name:K
Last Name:HARRIS
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 1:306 KNELSTON OAK DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7297
Mailing Address - Country:US
Mailing Address - Phone:469-363-5090
Mailing Address - Fax:
Practice Address - Street 1:306 KNELSTON OAK DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7297
Practice Address - Country:US
Practice Address - Phone:469-363-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care