Provider Demographics
NPI:1497528723
Name:HARRY, JESSICA LAUREN (MSN, RN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LAUREN
Last Name:HARRY
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2784 N DECATUR RD STE 120
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5993
Mailing Address - Country:US
Mailing Address - Phone:404-423-7112
Mailing Address - Fax:
Practice Address - Street 1:2784 N DECATUR RD STE 120
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5993
Practice Address - Country:US
Practice Address - Phone:404-423-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN296926363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse