Provider Demographics
NPI:1134439359
Name:HARRIS, GERALD JR
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:HARRIS
Suffix:JR
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 1:1327 POINDEXTER ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-2428
Mailing Address - Country:US
Mailing Address - Phone:757-545-4551
Mailing Address - Fax:757-545-4311
Practice Address - Street 1:1327 POINDEXTER ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2428
Practice Address - Country:US
Practice Address - Phone:757-545-4551
Practice Address - Fax:757-545-4311
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705-048516A171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications