Individual
MRS. KELLY VIRGA HARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
256 MCMILLAN RD, DACULA, GA 30019-2337
(678) 712-4184
(770) 353-9819
Mailing address
256 MCMILLAN RD, DACULA, GA 30019-2337
(678) 712-4184
(770) 353-9819
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN214516
GA
363LF0000X
Family Nurse Practitioner
F10220788
GA
363LF0000X
Family Nurse Practitioner
Primary
RN214516
GA
Other
Enumeration date
03/07/2023
Last updated
07/02/2024
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