Provider Demographics
NPI:1114476827
Name:HARRIS, OTHA III (FOUNDER, CEO,)
Entity Type:Individual
Prefix:
First Name:OTHA
Middle Name:
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:FOUNDER, CEO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132195
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75313-2195
Mailing Address - Country:US
Mailing Address - Phone:469-719-5589
Mailing Address - Fax:
Practice Address - Street 1:4208 CABELL DR APT 532
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3697
Practice Address - Country:US
Practice Address - Phone:469-719-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle