Provider Demographics
NPI:1922173889
Name:HARRIS, TONI (MD)
Entity Type:Individual
Prefix:DR
First Name:TONI
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
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:PO BOX 3426
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0426
Mailing Address - Country:US
Mailing Address - Phone:910-395-5590
Mailing Address - Fax:910-395-5598
Practice Address - Street 1:2035 VALLEYGATE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3688
Practice Address - Country:US
Practice Address - Phone:910-323-8454
Practice Address - Fax:910-321-0656
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35361208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8939989Medicaid
NC39989OtherBLUE CROSS OF NC
F92370Medicare UPIN
NC8939989Medicaid