Provider Demographics
NPI:1396938239
Name:JOHN J HARRIS MD PC
Entity type:Organization
Organization Name:JOHN J HARRIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-682-3035
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:38157-0618
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:38157-0618
Practice Address - Country:US
Practice Address - Phone:901-682-3035
Practice Address - Fax:901-682-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0049152084A0401X
TN049152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2000129OtherBLUE SHIELD
TN3383409Medicaid
TN262101820OtherRAILROAD MEDICARE/PIN
TNB02438Medicare UPIN
TN3383409Medicaid