Provider Demographics
NPI:1821139163
Name:G CHRISTIAN HARRIS MD INC PS
Entity Type:Organization
Organization Name:G CHRISTIAN HARRIS MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-418-6304
Mailing Address - Street 1:912 16TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3918
Mailing Address - Country:US
Mailing Address - Phone:206-418-6304
Mailing Address - Fax:206-418-6304
Practice Address - Street 1:912 16TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3918
Practice Address - Country:US
Practice Address - Phone:206-418-6304
Practice Address - Fax:206-418-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009727101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7849508Medicaid
WA7849508Medicaid
WA000102124Medicare ID - Type Unspecified
WA7849508Medicaid