Provider Demographics
NPI:1851199616
Name:KERISA HARRIOTT DMD P.C.
Entity type:Organization
Organization Name:KERISA HARRIOTT DMD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-696-6762
Mailing Address - Street 1:4500 WEST VILLAGE PL SE SUITE 2011
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-9243
Mailing Address - Country:US
Mailing Address - Phone:770-696-6762
Mailing Address - Fax:
Practice Address - Street 1:4500 WEST VILLAGE PL SE SUITE 2011
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-9243
Practice Address - Country:US
Practice Address - Phone:770-696-6762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1356607600OtherINDIVIDUAL NPI