Provider Demographics
NPI:1700867538
Name:HARRIS-FORD, LAURIE A (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:HARRIS-FORD
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:PO BOX 3799
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:931-245-8400
Mailing Address - Fax:931-245-7069
Practice Address - Street 1:2199 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-245-8400
Practice Address - Fax:931-245-8465
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21262208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3069046Medicaid
TN3069048Medicare ID - Type Unspecified
TN3069046Medicaid