Basic Information
| Provider Information | |||||||||
| NPI: | 1033558861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 SHAKERAG HL | ||||||||
| Address2: | STE 201 | ||||||||
| City: | PEACHTREE CITY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302694047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706644430 | ||||||||
| FaxNumber: | 7706647836 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 NORTHMEADOW PARKWAY | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300763871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706644430 | ||||||||
| FaxNumber: | 7706647836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2013 | ||||||||
| LastUpdateDate: | 02/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN171399 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.