Active NPI
Latisha Harris
- Health Service Clinic/Center
- Jonesboro, GA
National Provider Identifier
1245601137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Clinic/Center
- License
- 390588082
- Practice address
- 307 Kendrick Estates Dr
Jonesboro, GA 30238-2196 - Phone
- (770) 471-8037
- Fax
- (770) 471-8037
- NPI assigned
- Oct 17, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | 390588082 | GA | Primary |
Addresses
Primary practice location
307 Kendrick Estates Dr
Jonesboro, GA 30238-2196
Mailing address
307 Kendrick Estates Dr
Jonesboro, GA 30238-2196
Phone (770) 471-8037
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 390588082 | GA | MD | Health Service Clinic/Center |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445040000000",
"number": "1245601137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 KENDRICK ESTATES DR",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302382196",
"telephone_number": "770-471-8037",
"fax_number": "770-471-8037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 KENDRICK ESTATES DR",
"city": "JONESBORO",
"state": "GA",
"postal_code": "302382196",
"telephone_number": "770-471-8037",
"fax_number": "770-471-8037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "LATISHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-17",
"last_updated": "2015-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "261QH0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Health Service",
"state": "GA",
"license": "390588082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.