Provider Demographics
NPI:1073942678
Name:HIAWATHA HARRIS, M.D., INC.
Entity Type:Organization
Organization Name:HIAWATHA HARRIS, M.D., INC.
Other - Org Name:PATHWAYS TO WELLNESS MEDICATION CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HURSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-520-0005
Mailing Address - Street 1:5674 STONERIDGE DR STE 207
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8592
Mailing Address - Country:US
Mailing Address - Phone:925-520-0005
Mailing Address - Fax:925-520-0010
Practice Address - Street 1:5674 STONERIDGE DR STE 119
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8536
Practice Address - Country:US
Practice Address - Phone:925-520-0005
Practice Address - Fax:925-520-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty