Provider Demographics
NPI:1982480927
Name:HARALSON, JESSICA DEANNE (APRN, NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DEANNE
Last Name:HARALSON
Suffix:
Gender:F
Credentials:APRN, NP
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Mailing Address - Street 1:101 ASHBY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-2932
Mailing Address - Country:US
Mailing Address - Phone:678-630-1774
Mailing Address - Fax:
Practice Address - Street 1:3320 OLD JEFFERSON RD BLDG 800
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-353-2990
Practice Address - Fax:706-353-2992
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA292783363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology