Provider Demographics
NPI:1184060212
Name:HARRIS, FELISA
Entity type:Individual
Prefix:
First Name:FELISA
Middle Name:
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:PO BOX 3532
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-7532
Mailing Address - Country:US
Mailing Address - Phone:404-556-7297
Mailing Address - Fax:678-922-7329
Practice Address - Street 1:111 PETROL PT
Practice Address - Street 2:SUITE 200
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1550
Practice Address - Country:US
Practice Address - Phone:404-556-7297
Practice Address - Fax:678-922-7329
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator