Individual
MS. PENNY LONG HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. ED., CCC-SLP
Contact information
Practice address
3220 HIGHWAY 112, CAMILLA, GA 31730-4750
(229) 336-0742
Mailing address
99 E BROAD ST, CAMILLA, GA 31730-1807
(229) 336-8255
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
003443
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00717417D
—
GA
Enumeration date
06/22/2006
Last updated
03/18/2013
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