Provider Demographics
NPI:1447051016
Name:HARRIS, JONATHAN FRANKLIN
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:FRANKLIN
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PROTEUS AVE
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2836
Mailing Address - Country:US
Mailing Address - Phone:706-802-9309
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 87
Practice Address - Street 2:NAVAL SUBMARINE BASE NEW LONDON
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349
Practice Address - Country:US
Practice Address - Phone:706-802-9309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider