Healthcare Provider Details

I. General information

NPI: 1962510313
Provider Name (Legal Business Name): JEFFREY WILLIAM HARRIS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HOLMES CT STE 100
POOLER GA
31322-4801
US

IV. Provider business mailing address

6 HOLMES CT STE 100
POOLER GA
31322-4801
US

V. Phone/Fax

Practice location:
  • Phone: 912-254-4401
  • Fax: 912-330-4319
Mailing address:
  • Phone: 912-254-4401
  • Fax: 912-330-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN199652
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP199652
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: