Provider Demographics
NPI:1740261809
Name:LATIMER, HARRISON ARMISTEAD (MD)
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:ARMISTEAD
Last Name:LATIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-216-5633
Mailing Address - Fax:704-639-0785
Practice Address - Street 1:810 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6253
Practice Address - Country:US
Practice Address - Phone:704-216-5633
Practice Address - Fax:704-639-0785
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500643207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951124Medicaid