Provider Demographics
NPI:1740814342
Name:HARRIS, TENEAL JOHNSON
Entity type:Individual
Prefix:
First Name:TENEAL
Middle Name:JOHNSON
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 1:102 DERRINGER CT
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-9550
Mailing Address - Country:US
Mailing Address - Phone:478-397-3514
Mailing Address - Fax:
Practice Address - Street 1:2420 WINDSOR SPRING RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4668
Practice Address - Country:US
Practice Address - Phone:706-790-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily