Active NPI
Jackie Harmon
- Adult Health Nurse Practitioner
- Austell, GA
National Provider Identifier
1639499007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- RN075610
- Practice address
- 1810 Mulkey Rd
Suite 105
Austell, GA 30106-1151 - Phone
- (770) 944-0686
- Fax
- (770) 948-9341
- NPI assigned
- Jun 8, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | RN075610 | GA | Primary |
Addresses
Primary practice location
1810 Mulkey Rd
Suite 105
Austell, GA 30106-1151
Mailing address
1810 Mulkey Rd
Suite 105
Austell, GA 30106-1151
Phone (770) 944-0686
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN075610 | GA | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellstar Health System, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Point of Service
- Marietta, GA
- NPI 1437219656
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278547200000",
"number": "1639499007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1810 MULKEY RD",
"address_2": "SUITE 105",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061151",
"telephone_number": "770-944-0686",
"fax_number": "770-948-9341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1810 MULKEY RD",
"address_2": "SUITE 105",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061151",
"telephone_number": "770-944-0686",
"fax_number": "770-948-9341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARMON",
"first_name": "JACKIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-08",
"last_updated": "2010-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "GA",
"license": "RN075610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.