Provider Demographics
NPI:1841511474
Name:HARRIS, SHIRLEY JEANETTA
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:JEANETTA
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 1:1740 CHRISTIAN CIR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-5234
Mailing Address - Country:US
Mailing Address - Phone:770-983-8033
Mailing Address - Fax:
Practice Address - Street 1:1740 CHRISTIAN CIR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-5234
Practice Address - Country:US
Practice Address - Phone:770-983-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide