MEDICARE: MRS. JANICE T HARRIS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	101268	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1238PA	OTHER		BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306821582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE T HARRIS PA

Provider Business Mailing Address
First Line	:	7000 SHANNON WILLOW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1318
Country	:	US
Telephone Number	:	704-927-7300
Fax Number	:	704-927-7301

Provider Business Practice Location Address
First Line	:	2607 E 7TH ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4307
Country	:	US
Telephone Number	:	704-372-3714
Fax Number	:	704-333-4601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	04/30/2010

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