Provider Demographics
NPI:1730947284
Name:HARRIS, ALYSON (LMT)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALY
Other - Middle Name:
Other - Last Name:O'KERNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:9765 MOSS POINTE PATH
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-6904
Mailing Address - Country:US
Mailing Address - Phone:770-398-9388
Mailing Address - Fax:
Practice Address - Street 1:103 BARNES STREET
Practice Address - Street 2:OFFICE 6
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-398-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012722225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist