Provider Demographics
NPI:1396723342
Name:HARRIS, JEFFREY ALAN (MSN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MSN
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Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:478-745-6130
Mailing Address - Fax:478-745-4443
Practice Address - Street 1:308 COLISEUM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3808
Practice Address - Country:US
Practice Address - Phone:478-745-6130
Practice Address - Fax:478-745-4443
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN109366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA432780319HMedicaid
GA432780319GMedicaid
GA20250I9814Medicare PIN
GA432780319GMedicaid