Provider Demographics
NPI:1013066307
Name:HARMON, JENNIFER (CSA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:JANAYE
Other - Middle Name:
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SA-C
Mailing Address - Street 1:14390 HOPEWELL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6929
Mailing Address - Country:US
Mailing Address - Phone:404-394-0714
Mailing Address - Fax:
Practice Address - Street 1:14390 HOPEWELL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-6929
Practice Address - Country:US
Practice Address - Phone:404-394-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist