Healthcare Provider Details

I. General information

NPI: 1386700086
Provider Name (Legal Business Name): MR. GREGORY DEON HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W BROAD AVE
ALBANY GA
31701-2468
US

IV. Provider business mailing address

526 W BROAD AVE
ALBANY GA
31701-2468
US

V. Phone/Fax

Practice location:
  • Phone: 229-435-3922
  • Fax: 229-435-3945
Mailing address:
  • Phone: 229-435-3922
  • Fax: 229-435-3945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number047-R-0007
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number047-R-0007
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number047-R-0007
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: