Provider Demographics
NPI:1013755297
Name:HARRISON, WILLIAM KEVIN (CCSH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KEVIN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SWISS HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-8476
Mailing Address - Country:US
Mailing Address - Phone:336-756-2063
Mailing Address - Fax:
Practice Address - Street 1:130 SWISS HAVEN DR
Practice Address - Street 2:
Practice Address - City:PILOT MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:27041-8476
Practice Address - Country:US
Practice Address - Phone:336-756-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program