Provider Demographics
NPI:1841904356
Name:HARRIS, MELINDA
Entity type:Individual
Prefix:
First Name:MELINDA
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 1:106 COLONY PARK DR STE 800B
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2794
Mailing Address - Country:US
Mailing Address - Phone:470-354-6259
Mailing Address - Fax:
Practice Address - Street 1:106 COLONY PARK DR STE 800B
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2794
Practice Address - Country:US
Practice Address - Phone:470-354-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA885389756Medicaid