Provider Demographics
NPI:1952694416
Name:HARRIS, JENNIFER ANNE (CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:975 JOHNSON FERRY ROAD NE
Mailing Address - Street 2:SUITE #340
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1605
Mailing Address - Country:US
Mailing Address - Phone:404-785-4688
Mailing Address - Fax:404-785-4750
Practice Address - Street 1:975 JOHNSON FERRY ROAD NE
Practice Address - Street 2:SUITE #340
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-4688
Practice Address - Fax:404-785-4750
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188328363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics