Provider Demographics
NPI:1114042082
Name:HARRIS, MARGARET F (PA-C, MPH)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:F
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HILL POND LN
Mailing Address - Street 2:
Mailing Address - City:STATSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458
Mailing Address - Country:US
Mailing Address - Phone:912-489-1629
Mailing Address - Fax:912-489-1630
Practice Address - Street 1:116 HILL POND LN
Practice Address - Street 2:
Practice Address - City:STATSBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-489-1629
Practice Address - Fax:912-489-1630
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004047363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL602328090AMedicaid
ILF400094218OtherNATIONAL GOVERNMENT SERVICES MEDICARE PTAN
P01256004OtherRAILROAD MEDICARE PTAN
ILF400094218OtherNATIONAL GOVERNMENT SERVICES MEDICARE PTAN