Provider Demographics
NPI:1588555619
Name:HARRIS, ELIZA GRACE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ELIZA
Middle Name:GRACE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:744 TWIN OAKS DR APT 1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4058
Mailing Address - Country:US
Mailing Address - Phone:706-969-9729
Mailing Address - Fax:
Practice Address - Street 1:2711 IRVIN WAY STE 205
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1724
Practice Address - Country:US
Practice Address - Phone:404-355-1446
Practice Address - Fax:404-328-0226
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA13197363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant