Provider Demographics
NPI:1811136468
Name:HARRIS, ADAM S (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:HARRIS
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 530604
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35253-0604
Mailing Address - Country:US
Mailing Address - Phone:205-879-8294
Mailing Address - Fax:205-879-8259
Practice Address - Street 1:4600 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5028
Practice Address - Country:US
Practice Address - Phone:205-621-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32505208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051139469OtherBLUE CROSS BLUE SHIELD
AL152487Medicaid