Provider Demographics
NPI:1427016534
Name:HARRIS, CHARLES L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 EAST 65TH ST
Mailing Address - Street 2:BLDG 34
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6007
Mailing Address - Country:US
Mailing Address - Phone:912-353-7900
Mailing Address - Fax:912-353-7906
Practice Address - Street 1:836 EAST 65TH ST
Practice Address - Street 2:BLDG 34
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-353-7900
Practice Address - Fax:912-353-7906
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046302207W00000X, 208600000X, 207WX0107X
SCMD23446207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00829551EMedicaid
SCGPA790Medicaid
GAF98054Medicare UPIN
GA18BDFVSMedicare PIN