Provider Demographics
NPI:1053283671
Name:HARRISON MACNELLIS, DMD, LLC
Entity type:Organization
Organization Name:HARRISON MACNELLIS, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACNELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-763-5198
Mailing Address - Street 1:157 HODGES ST
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-3295
Mailing Address - Country:US
Mailing Address - Phone:706-894-1919
Mailing Address - Fax:
Practice Address - Street 1:157 HODGES ST
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-3295
Practice Address - Country:US
Practice Address - Phone:706-894-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental