Provider Demographics
NPI:1053815985
Name:MALCOLM, HARRISON REID
Entity Type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:REID
Last Name:MALCOLM
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 1:522 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2739
Mailing Address - Country:US
Mailing Address - Phone:803-608-7890
Mailing Address - Fax:
Practice Address - Street 1:522 POPLAR ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2739
Practice Address - Country:US
Practice Address - Phone:803-608-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program