Provider Demographics
NPI:1821209313
Name:HARRIS, ROBERT T (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:603 BEAMAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2650
Mailing Address - Country:US
Mailing Address - Phone:910-590-0027
Mailing Address - Fax:910-590-3258
Practice Address - Street 1:603 BEAMAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2650
Practice Address - Country:US
Practice Address - Phone:910-590-0027
Practice Address - Fax:910-590-3258
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00178363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant