Provider Demographics
NPI:1073004602
Name:HARRISON, JULIA DANIELLE (OD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:DANIELLE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4347
Mailing Address - Country:US
Mailing Address - Phone:229-246-1600
Mailing Address - Fax:229-246-1636
Practice Address - Street 1:1601 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4347
Practice Address - Country:US
Practice Address - Phone:229-246-1600
Practice Address - Fax:229-246-1636
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003116152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT003116OtherSTATE LICENSE