Provider Demographics
NPI:1306821582
Name:HARRIS, JANICE T (PA)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:T
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 SHANNON WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-1318
Mailing Address - Country:US
Mailing Address - Phone:704-927-7300
Mailing Address - Fax:704-927-7301
Practice Address - Street 1:2607 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4307
Practice Address - Country:US
Practice Address - Phone:704-372-3714
Practice Address - Fax:704-333-4601
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1238PAOtherBCBS
SC0463PAMedicaid
SC0463PAMedicaid