Provider Demographics
NPI:1336344142
Name:HARRIS, WENDY M (FNP-C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 ROYCE DR STE 100A
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2478
Mailing Address - Country:US
Mailing Address - Phone:770-557-6444
Mailing Address - Fax:
Practice Address - Street 1:101 BECKETT LN STE 502
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7160
Practice Address - Country:US
Practice Address - Phone:678-817-1000
Practice Address - Fax:678-817-1001
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113723 NP363L00000X
GARN113723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner