Individual
DR. KERISA HARRIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1111 JOHNSON FERRY RD # 10, MARIETTA, GA 30068-2181
(718) 764-7479
Mailing address
1512 JUSTINE WAY SE, MABLETON, GA 30126-2839
(718) 764-7479
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
056887
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN123004
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2012
Last updated
07/21/2023
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