Individual provider Active NPI

Gina R Harris, D.O.

  • Obstetrics & Gynecology Physician
  • Lawrenceville, GA
National Provider Identifier
1104272194
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
85893 Issued in GA
Practice address
500 Medical Center Blvd Ste 190
Lawrenceville, GA 30046-3379
Phone
(770) 643-4115
Fax
(678) 377-3820
NPI assigned
May 9, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 85893 GA Primary

Addresses

Primary practice location

500 Medical Center Blvd Ste 190
Lawrenceville, GA 30046-3379

Mailing address

500 Medical Center Blvd Ste 190
Lawrenceville, GA 30046-3379
Phone (770) 643-4115

Other identifiers 1

IdentifierTypeStateIssuer
300034164AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220329000467 GA Practitioner - Obstetrics/Gynecology 1759675960 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Philadelphia College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gwinnett Physician Group, LLCGroup PAC ID 9133211139, 112 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-4321

500 Medical Ctr Blvd
Suite 190
Lawrenceville, GA 30046-3379
Phone (678) 312-3290

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
85893GAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gwinnett Physician Group, LLC Obstetrics & Gynecology CurrentSince Feb 5, 2024 Accepting new patients
Women'S Community Care, PC PastSince Jun 1, 2020 Accepting new patients
Southern Crescent Women'S Healthcare PC Obstetrics & Gynecology PastSince Jun 1, 2020 Accepting new patients
Northside Hospital, Inc. Past Accepting new patients

Locations

500 Medical Center Blvd
Ste 190
Lawrenceville, GA 30046
Phone (678) 312-3290

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1104272194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 190",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463379",
            "telephone_number": "770-643-4115",
            "fax_number": "678-377-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MEDICAL CENTER BLVD STE 190",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463379",
            "telephone_number": "770-643-4115",
            "fax_number": "678-377-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "GINA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-09",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "85893",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300034164A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.