Provider Demographics
NPI:1497166623
Name:HARRIS, JOHNNY II (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:HARRIS
Suffix:II
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 1:1700 CENTER ST
Mailing Address - Street 2:CWEB 1, RM 1538
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688
Mailing Address - Country:US
Mailing Address - Phone:251-471-7117
Mailing Address - Fax:
Practice Address - Street 1:1080 PEACHTREE ST NE STE 12
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-6857
Practice Address - Country:US
Practice Address - Phone:404-253-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081077207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine