Provider Demographics
NPI:1073676573
Name:HARPER, JEANIE
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PERRY HOUSE RD
Mailing Address - Street 2:PO DRAWER 1009
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8837
Mailing Address - Country:US
Mailing Address - Phone:229-423-9237
Mailing Address - Fax:
Practice Address - Street 1:171 PERRY HOUSE RD
Practice Address - Street 2:PO DRAWER 1009
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8837
Practice Address - Country:US
Practice Address - Phone:229-423-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6067124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist