Provider Demographics
NPI:1396593604
Name:HARRIS, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 WELLBORN RD #424
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074
Mailing Address - Country:US
Mailing Address - Phone:404-694-7672
Mailing Address - Fax:404-779-7702
Practice Address - Street 1:1544 WELLBORN RD #424
Practice Address - Street 2:
Practice Address - City:REDAN
Practice Address - State:GA
Practice Address - Zip Code:30074
Practice Address - Country:US
Practice Address - Phone:404-694-7672
Practice Address - Fax:404-779-7702
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAP3M3Z6D7246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy