Provider Demographics
NPI:1770644031
Name:HARRIS, CEDRIC LEON (MD)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:LEON
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 1:3004 ALLISON BONNETT MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2317
Mailing Address - Country:US
Mailing Address - Phone:205-491-3299
Mailing Address - Fax:
Practice Address - Street 1:3004 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2317
Practice Address - Country:US
Practice Address - Phone:205-491-3299
Practice Address - Fax:205-744-8761
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009941472Medicaid
ALH06644OtherVIVA
ALH06644OtherUNITED HEALTHCARE
AL515-38860OtherBCBS
ALH06644OtherHEALTHSPRING
ALH06644Medicare UPIN
AL009941472Medicaid