Healthcare Provider Details

I. General information

NPI: 1114738002
Provider Name (Legal Business Name): JAMIE HARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 CONNER ST STE 3214
DETROIT MI
48213-3498
US

IV. Provider business mailing address

5555 CONNER ST STE 3214
DETROIT MI
48213-3498
US

V. Phone/Fax

Practice location:
  • Phone: 865-378-9538
  • Fax:
Mailing address:
  • Phone: 865-378-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: