Provider Demographics
NPI:1245677913
Name:HARRIS, EDITH J (PHD, RD, LDN)
Entity type:Individual
Prefix:DR
First Name:EDITH
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-6163
Mailing Address - Country:US
Mailing Address - Phone:225-923-3957
Mailing Address - Fax:225-387-2400
Practice Address - Street 1:660 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6163
Practice Address - Country:US
Practice Address - Phone:225-923-3957
Practice Address - Fax:225-387-2400
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA567133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered