Provider Demographics
NPI:1023901493
Name:HARRIS, CYNTHIA DENISE (LPN)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WILLIAMS DR APT 431
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6170
Mailing Address - Country:US
Mailing Address - Phone:404-721-2125
Mailing Address - Fax:404-721-2125
Practice Address - Street 1:425 WILLIAMS DR APT 431
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6170
Practice Address - Country:US
Practice Address - Phone:770-686-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071720164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse