Provider Demographics
NPI:1023180031
Name:CRAIG D HARRIS MD PA
Entity Type:Organization
Organization Name:CRAIG D HARRIS MD PA
Other - Org Name:SELECT MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:DYER
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:846-873-5606
Mailing Address - Street 1:310 N GUM ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6874
Mailing Address - Country:US
Mailing Address - Phone:843-873-5606
Mailing Address - Fax:843-873-8861
Practice Address - Street 1:310 N GUM ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6874
Practice Address - Country:US
Practice Address - Phone:843-873-5606
Practice Address - Fax:843-873-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC166352081P2900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty