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General NPI Number Information
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NPI Number | 1073771762
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Entity Type | Individual
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Provider Name | JACQUELINE D HARRIS MD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 35 COLLIER RD NW STE 775
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City | ATLANTA
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State | GA
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Zip | 30309-1608
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Country | US
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Telephone | 404-350-4280
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Fax |
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Provider Business Mailing Address
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Address Line | 815 WELDON RD
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City | PALMETTO
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State | GA
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Zip | 30268-1667
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Country | US
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Telephone | 678-593-1900
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Fax | 678-593-1920
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2010-01838
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 63934
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License Number State | GA
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