Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 011586 | GA |
Y | 213EG0000X | General Practice | 011586 | GA |
NPI | 1003097478 |
---|---|
Provider Name | Winifred Jones Harris |
First Address | Dawsonville, GA 30534-6276 |
Second Address | Dawsonville, GA 30534-6276 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 04/02/2010 |