Provider Demographics
NPI:1518432277
Name:HARRIS, JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4073 LAVISTA RD STE 371
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5221
Mailing Address - Country:US
Mailing Address - Phone:770-376-5784
Mailing Address - Fax:770-376-5879
Practice Address - Street 1:4073 LAVISTA RD STE 371
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5221
Practice Address - Country:US
Practice Address - Phone:770-376-5784
Practice Address - Fax:770-376-5789
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor