Provider Demographics
NPI:1821328741
Name:WOMEN'S HEALTH AT WATER'S EDGE
Entity Type:Organization
Organization Name:WOMEN'S HEALTH AT WATER'S EDGE
Other - Org Name:J DAVID HARRIS MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-756-9487
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-0699
Mailing Address - Country:US
Mailing Address - Phone:334-756-9487
Mailing Address - Fax:334-756-9448
Practice Address - Street 1:267 FOB JAMES DR
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-5077
Practice Address - Country:US
Practice Address - Phone:334-756-9487
Practice Address - Fax:334-756-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19790207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27943Medicare UPIN
AL000038732Medicare PIN