Provider Demographics
NPI:1154034452
Name:HARRIEL, AMY QUADRENA (CSFA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:QUADRENA
Last Name:HARRIEL
Suffix:
Gender:F
Credentials:CSFA
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 471
Mailing Address - Street 2:
Mailing Address - City:LOVEJOY
Mailing Address - State:GA
Mailing Address - Zip Code:30250-0471
Mailing Address - Country:US
Mailing Address - Phone:404-380-0360
Mailing Address - Fax:
Practice Address - Street 1:11565 CREEKSTONE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3467
Practice Address - Country:US
Practice Address - Phone:404-380-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207688246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant