Provider Demographics
NPI:1104700327
Name:HARRIS HERITAGE HOLDINGS LLC
Entity type:Organization
Organization Name:HARRIS HERITAGE HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JEREL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:478-775-8929
Mailing Address - Street 1:6687 SKIPPER RD APT 115
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-6456
Mailing Address - Country:US
Mailing Address - Phone:478-775-8929
Mailing Address - Fax:
Practice Address - Street 1:6687 SKIPPER RD APT 115
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-6456
Practice Address - Country:US
Practice Address - Phone:478-775-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center