Provider Demographics
NPI:1881708931
Name:HARRIS, YOLANDA (MD)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 E EH CRUMP BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-5310
Mailing Address - Country:US
Mailing Address - Phone:901-261-2000
Mailing Address - Fax:901-946-9262
Practice Address - Street 1:360 E EH CRUMP BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-5310
Practice Address - Country:US
Practice Address - Phone:901-261-2000
Practice Address - Fax:901-946-9262
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3886300Medicaid
TN3886300Medicare ID - Type Unspecified
TN3886300Medicaid