Provider Demographics
NPI:1013474733
Name:HARMON, JULIE E'LANE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:E'LANE
Last Name:HARMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 SISSON BND NE
Mailing Address - Street 2:
Mailing Address - City:RESACA
Mailing Address - State:GA
Mailing Address - Zip Code:30735-6332
Mailing Address - Country:US
Mailing Address - Phone:706-263-2844
Mailing Address - Fax:
Practice Address - Street 1:400 TIMMS RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7016
Practice Address - Country:US
Practice Address - Phone:706-625-0022
Practice Address - Fax:706-625-8586
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005652225100000X
GA10492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist