Provider Demographics
NPI:1932970589
Name:HARRIS, DELICIA RENEE (LPN)
Entity Type:Individual
Prefix:MS
First Name:DELICIA
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2382
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-1734
Mailing Address - Country:US
Mailing Address - Phone:203-491-6267
Mailing Address - Fax:
Practice Address - Street 1:100 POSTMASTER DR UNIT 2382
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2824
Practice Address - Country:US
Practice Address - Phone:203-491-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN101842164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty