Provider Demographics
NPI:1649432923
Name:HARRISON, FARRYN JEVANNA (DDS)
Entity type:Individual
Prefix:DR
First Name:FARRYN
Middle Name:JEVANNA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 S HAIRSTON RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2720
Mailing Address - Country:US
Mailing Address - Phone:404-297-6635
Mailing Address - Fax:813-289-4500
Practice Address - Street 1:1147 S HAIRSTON RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2720
Practice Address - Country:US
Practice Address - Phone:404-297-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0132201223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery