| Doctor Name: | ANGELA M HARRISH |
| NPI Number: | 1598825515 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 115839 |
| Business Practice Address: | 655 7th St Bldg 700-a 78 Mdos/sgoc Robins Afb, GA - 310982227 |
| Business Phone Number: | 4783278220 |
| Business Fax Number: | |
| Mailing Address: | 107 Chalet Cv, CENTERVILLE |
| State: | GA |
| Postal Code: | 310286511 |
| Phone Number: | 4783332413 |
| Fax Number: | |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 09/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 115839 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |