Provider Demographics
NPI:1962510313
Name:HARRIS, JEFFREY WILLIAM (PMHNP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WILLIAM
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HOLMES CT STE 100
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4801
Mailing Address - Country:US
Mailing Address - Phone:912-254-4401
Mailing Address - Fax:912-330-4319
Practice Address - Street 1:6 HOLMES CT STE 100
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4801
Practice Address - Country:US
Practice Address - Phone:912-254-4401
Practice Address - Fax:912-330-4319
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199652163W00000X
GAAPRN-NP199652363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse