Provider Demographics
NPI:1477582807
Name:HARRISON, XAVIER ALFRED (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:ALFRED
Last Name:HARRISON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 KINCEY AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6541
Mailing Address - Country:US
Mailing Address - Phone:704-947-5005
Mailing Address - Fax:877-881-8455
Practice Address - Street 1:9930 KINCEY AVE STE 165
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6541
Practice Address - Country:US
Practice Address - Phone:704-947-5005
Practice Address - Fax:877-881-8455
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102590363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA3120OtherMEDCOST
NCA3120OtherMEDCOST
NC2751568AMedicare PIN
NCNCA697AMedicare UPIN