Provider Demographics
NPI:1972172898
Name:HARRIS, WILLIAM M
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-0019
Mailing Address - Country:US
Mailing Address - Phone:304-457-1670
Mailing Address - Fax:
Practice Address - Street 1:109 WABASH AVE
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-0019
Practice Address - Country:US
Practice Address - Phone:304-841-8554
Practice Address - Fax:304-457-1296
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist