Provider Demographics
NPI:1992863864
Name:HARRIS, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
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 1:5050 POPLAR AVE
Mailing Address - Street 2:SUITE 618
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38157-0101
Mailing Address - Country:US
Mailing Address - Phone:901-682-3035
Mailing Address - Fax:901-682-3049
Practice Address - Street 1:5050 POPLAR AVE
Practice Address - Street 2:SUITE 618
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-0101
Practice Address - Country:US
Practice Address - Phone:901-682-3035
Practice Address - Fax:901-682-3049
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN04915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN262101820OtherRAILROAD MEDICARE
TN002000129OtherTN BLUE SHIELD
TN3383409Medicaid
TN3383409Medicaid