Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6067 | GA |
NPI | 1073676573 |
---|---|
Provider Name | Jeanie Harper |
First Address | Fitzgerald, GA 31750-8837 |
Second Address | Fitzgerald, GA 31750-8837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |