Provider Demographics
NPI:1568473957
Name:HARRIS, CHRISTOPHER SHANNON (R, MR)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHANNON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:R, MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BARRINGTON HALL DR
Mailing Address - Street 2:APT 211
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-0707
Mailing Address - Country:US
Mailing Address - Phone:478-973-0133
Mailing Address - Fax:
Practice Address - Street 1:1504 HARDEMAN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1416
Practice Address - Country:US
Practice Address - Phone:478-745-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
319348247100000X, 2471C3402X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging