Provider Demographics
NPI:1730778705
Name:HARRISON, HEATHER ANN (PHD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E GATE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-4201
Mailing Address - Country:US
Mailing Address - Phone:229-221-2010
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC
Practice Address - Street 2:881 USS JAMES MADISON ROAD
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31547
Practice Address - Country:US
Practice Address - Phone:912-573-4215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2052103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist