Healthcare Provider Details

I. General information

NPI: 1902019110
Provider Name (Legal Business Name): JAY A HARRIS DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 BROOKSTONE CENTRE PKWY STE 200
COLUMBUS GA
31904
US

IV. Provider business mailing address

2570 BROOKSTONE CENTRE PKWY STE 200
COLUMBUS GA
31904
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-5627
  • Fax: 706-324-2231
Mailing address:
  • Phone: 706-324-5627
  • Fax: 706-324-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JAY A HARRIS
Title or Position: OWNER
Credential: DMD
Phone: 706-324-5627