Provider Demographics
NPI:1801360854
Name:HARRIS, QUINTON CORTEZ
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:CORTEZ
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 1:1041 WOODS FERRY RD APT 6
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4082
Mailing Address - Country:US
Mailing Address - Phone:615-561-2617
Mailing Address - Fax:
Practice Address - Street 1:1041 WOODS FERRY RD APT 6
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-4082
Practice Address - Country:US
Practice Address - Phone:615-561-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN126910495343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)