NPI 1073926812
Ivy Harris
Practice location
- Address
- 4613 Marthas Way, Grovetown, GA 30813-2205
- Phone
- (732) 962-5450
- Mailing address
- 4613 Martha's Way, Grovetown, GA 30813
Registered specialties
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
Registry record
- NPI
- 1073926812
- Entity type
- Individual
- Sex (as registered)
- Female
- NPI issued
- 10 Jun 2014
- Record last updated
- 10 Jun 2014
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.