Provider Demographics
NPI:1194717264
Name:HARRISON, SABRINA DAVINA (MD)
Entity type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:DAVINA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PEACHTREE RD NE
Mailing Address - Street 2:STE 520-623
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3287
Mailing Address - Country:US
Mailing Address - Phone:404-520-3330
Mailing Address - Fax:770-670-6146
Practice Address - Street 1:1875 OLD ALABAMA RD
Practice Address - Street 2:STE. 210
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2272
Practice Address - Country:US
Practice Address - Phone:770-670-6145
Practice Address - Fax:770-670-6146
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA54900OtherMEDICAL LICENSE
GA307761352GMedicaid
GA16BBCLFMedicare ID - Type Unspecified