Individual
GWEN HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14901 RIVER ST, BLAKELY, GA 39823-2499
(229) 723-8099
Mailing address
14901 RIVER ST, BLAKELY, GA 39823-2499
(229) 723-8315
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
RN049410
GA
Other
Enumeration date
11/29/2023
Last updated
11/29/2023
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