Provider Demographics
NPI:1033399274
Name:HARRIS, BOBBY EUGENE
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:EUGENE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 RED CEDAR DR
Mailing Address - Street 2:APT 1 C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-7190
Mailing Address - Country:US
Mailing Address - Phone:336-442-4706
Mailing Address - Fax:336-275-8962
Practice Address - Street 1:202 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2608
Practice Address - Country:US
Practice Address - Phone:336-442-4706
Practice Address - Fax:336-275-8962
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator