Provider Demographics
NPI:1275837791
Name:HARRIGAN, JOHANE CAM
Entity Type:Individual
Prefix:
First Name:JOHANE
Middle Name:CAM
Last Name:HARRIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANE
Other - Middle Name:CAM
Other - Last Name:HARRIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:124 ROPEMAKER LANE
Mailing Address - Street 2:124 RPEMAKER LANE
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410
Mailing Address - Country:US
Mailing Address - Phone:912-323-8552
Mailing Address - Fax:
Practice Address - Street 1:124 ROPEMAKER LANE
Practice Address - Street 2:124 RPEMAKER LANE
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410
Practice Address - Country:US
Practice Address - Phone:912-323-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA0600X261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care