Provider Demographics
NPI:1003944430
Name:HARRIS, CHAUNDRA ELOIS (MA)
Entity type:Individual
Prefix:MS
First Name:CHAUNDRA
Middle Name:ELOIS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 CRIMSON OAK CT # A
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-6501
Mailing Address - Country:US
Mailing Address - Phone:404-277-9869
Mailing Address - Fax:
Practice Address - Street 1:5850 CRIMSON OAK CT # A
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-6501
Practice Address - Country:US
Practice Address - Phone:404-277-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005643235Z00000X
NC12816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA450358277AMedicaid