Healthcare Provider Details

I. General information

NPI: 1447051016
Provider Name (Legal Business Name): JONATHAN FRANKLIN HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 87 NAVAL SUBMARINE BASE NEW LONDON
GROTON CT
06349
US

IV. Provider business mailing address

126 PROTEUS AVE
GROTON CT
06340-2836
US

V. Phone/Fax

Practice location:
  • Phone: 706-802-9309
  • Fax:
Mailing address:
  • Phone: 706-802-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: