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General NPI Number Information
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NPI Number | 1215422043
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Entity Type | Organization
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Legal Business Name | JACQUELINE HARRIS, MD, LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 107 SEAGRASS STATION RD
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City | BLUFFTON
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State | SC
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Zip | 29910-3110
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Country | US
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Telephone | 836-843-8200
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Fax | 843-836-8595
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Provider Business Mailing Address
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Address Line | PO BOX 14624
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City | SAVANNAH
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State | GA
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Zip | 31416-1624
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Country | US
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Telephone | 843-422-4413
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Fax | 866-848-1697
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE HARRIS
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Credential | MD
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Telephone | 843-422-4413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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