Provider Demographics
NPI:1609877315
Name:HARRIS, HARVEY A
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ENTERPRISE COURT
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-321-2585
Mailing Address - Fax:706-321-2586
Practice Address - Street 1:1900 10TH AVE
Practice Address - Street 2:211
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3600
Practice Address - Country:US
Practice Address - Phone:706-321-2585
Practice Address - Fax:706-321-2586
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037825207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDQWCMedicare ID - Type UnspecifiedMD