Provider Demographics
NPI:1902682826
Name:HARRISON, CARMEN VIRGINIA (WNHP-BC)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:VIRGINIA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:WNHP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 ROLLING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4156
Mailing Address - Country:US
Mailing Address - Phone:513-748-9144
Mailing Address - Fax:
Practice Address - Street 1:2755 ROLLING VIEW DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4156
Practice Address - Country:US
Practice Address - Phone:513-748-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA133308363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health