Provider Demographics
NPI:1568626133
Name:HARRIS, PAMELA LIN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LIN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FORT BRAGG RD
Mailing Address - Street 2:STE 3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7041
Mailing Address - Country:US
Mailing Address - Phone:910-483-3334
Mailing Address - Fax:910-483-7606
Practice Address - Street 1:2000 FORT BRAGG RD
Practice Address - Street 2:ST 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7041
Practice Address - Country:US
Practice Address - Phone:910-483-3334
Practice Address - Fax:910-483-7606
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-02028207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ487672Medicaid
AZZ141120Medicare Oscar/Certification