Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN190897 | GA |
NPI | 1003338195 |
---|---|
Provider Name | Mrs. Jamie Lynn Harrelson |
First Address | Macon, GA 31217-2805 |
Second Address | Macon, GA 31210-5039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2017 |
Last Update Date | 11/07/2017 |