Provider Demographics
NPI:1114010485
Name:HARRIS, JEFFREY D'NEIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D'NEIL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 NICKLAUS DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6064
Mailing Address - Country:US
Mailing Address - Phone:770-906-7430
Mailing Address - Fax:
Practice Address - Street 1:2450 VINSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31062-1622
Practice Address - Country:US
Practice Address - Phone:770-906-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000977413AMedicaid
GA68BBGKNMedicare ID - Type Unspecified
GA000977413AMedicaid