Provider Demographics
NPI:1083896807
Name:HARRIS, JEREMY E (BOCP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3819
Mailing Address - Country:US
Mailing Address - Phone:270-816-5888
Mailing Address - Fax:
Practice Address - Street 1:1108 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3819
Practice Address - Country:US
Practice Address - Phone:270-816-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC22326332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment