Individual provider Active NPI

Jeffrey William Harris, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Pooler, GA
National Provider Identifier
1962510313
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
APRN-NP199652 Issued in GA
Practice address
6 Holmes CT Ste 100
Pooler, GA 31322-4801
Phone
(912) 254-4401
Fax
(912) 330-4319
NPI assigned
Aug 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN199652 GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X APRN-NP199652 GA Primary

Addresses

Primary practice location

6 Holmes CT Ste 100
Pooler, GA 31322-4801

Mailing address

6 Holmes CT Ste 100
Pooler, GA 31322-4801
Phone (912) 254-4401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230215000139 GA Practitioner - Nurse Practitioner 0446622724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

6 Holmes CT
Suite 100
Pooler, GA 31322-4801
Phone (912) 254-4401

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
APRN-NP199652GAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC CurrentSince Jan 7, 2024 Accepting new patients
Gateway Community Service Board Past Accepting new patients

Locations

6 Holmes Ct
Ste 100
Pooler, GA 31322
Phone (912) 254-4401

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

Interoperability endpoints

  • Direct secure messaging: lifestancehealth.jeffreyharris@143219.advancedmd-direct.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1962510313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 HOLMES CT STE 100",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224801",
            "telephone_number": "912-254-4401",
            "fax_number": "912-330-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 HOLMES CT STE 100",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224801",
            "telephone_number": "912-254-4401",
            "fax_number": "912-330-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "JEFFREY",
        "middle_name": "WILLIAM",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN199652",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "APRN-NP199652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pooler, GA

Sources for this page

Verify at the official NPI Registry.