Organization
ANNUAL MEDICARE WELLNESS EXAMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIA HARRIS FNP (OWNER)
(706) 761-6553
Entity
Organization
Contact information
Practice address
1880 BRASELTON HWY STE 118, LAWRENCEVILLE, GA 30043-2877
(706) 761-6553
(678) 804-1852
Mailing address
1025 CAMPBELL PINE TRL, LAWRENCEVILLE, GA 30045-4306
(706) 761-6553
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
10/14/2022
Last updated
11/11/2022
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