Provider Demographics
NPI:1386004943
Name:HARRIS, RICHARD ALEXANDER JR (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALEXANDER
Last Name:HARRIS
Suffix:JR
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:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-978-3549
Practice Address - Street 1:633 BROOKDALE DR STE 300
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3471
Practice Address - Country:US
Practice Address - Phone:704-873-3250
Practice Address - Fax:704-873-2940
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant