Provider Demographics
NPI:1083113880
Name:HARRIS, JOSHUA FREEMAN (PA - C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:FREEMAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N JUSTICE ST # 16
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3410
Mailing Address - Country:US
Mailing Address - Phone:828-694-8385
Mailing Address - Fax:828-694-7654
Practice Address - Street 1:6503 BREVARD RD
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:NC
Practice Address - Zip Code:28729-8739
Practice Address - Country:US
Practice Address - Phone:828-890-4156
Practice Address - Fax:828-891-9276
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNN1355AOtherMEDICARE PTAN
NC1083113880Medicaid