Provider Demographics
NPI:1881634475
Name:HARRIS, KENNETH L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
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 1:2375 CHAMPIONS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6471
Mailing Address - Country:US
Mailing Address - Phone:334-745-6447
Mailing Address - Fax:334-742-0713
Practice Address - Street 1:2375 CHAMPIONS BLVD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6471
Practice Address - Country:US
Practice Address - Phone:334-745-6447
Practice Address - Fax:334-742-0713
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15999207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-27063OtherBCBS PROVIDER #
AL510-27063OtherBCBS PROVIDER #
ALF18539Medicare UPIN