Provider Demographics
NPI:1639188303
Name:HARRIS, JOE TANNER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:TANNER
Last Name:HARRIS
Suffix:
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 1:2888 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5347
Mailing Address - Country:US
Mailing Address - Phone:662-234-8286
Mailing Address - Fax:662-234-6644
Practice Address - Street 1:2888 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5347
Practice Address - Country:US
Practice Address - Phone:662-234-8286
Practice Address - Fax:662-234-6644
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10280208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121627Medicaid