Provider Demographics
NPI:1538775440
Name:HARRIS, JEFFERY
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WESTWOOD ST APT A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-6505
Mailing Address - Country:US
Mailing Address - Phone:251-513-5778
Mailing Address - Fax:
Practice Address - Street 1:405 WESTWOOD ST APT A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-6505
Practice Address - Country:US
Practice Address - Phone:251-513-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374700000X
AL6988997374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician