Healthcare Provider Details

I. General information

NPI: 1275046906
Provider Name (Legal Business Name): GENEVIEVE HOLL HARRIS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 POND RUN LN
JACKSONVILLE FL
32218-8984
US

IV. Provider business mailing address

165 POND RUN LN
JACKSONVILLE FL
32218-8984
US

V. Phone/Fax

Practice location:
  • Phone: 205-532-1008
  • Fax:
Mailing address:
  • Phone: 205-532-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY2147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: