Provider Demographics
NPI:1508138389
Name:HARRIS, GEORGE ANTHONY (DC LICENSED/CST/CFA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ANTHONY
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DC LICENSED/CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14911 FIRST BAPTIST LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6926
Mailing Address - Country:US
Mailing Address - Phone:301-728-6874
Mailing Address - Fax:301-317-3310
Practice Address - Street 1:1011 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-659-0240
Practice Address - Fax:202-955-5541
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0038246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant