Healthcare Provider Details

I. General information

NPI: 1477212355
Provider Name (Legal Business Name): ANTWANE HARRIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 20TH ST S
BIRMINGHAM AL
35205-2610
US

IV. Provider business mailing address

908 20TH ST S
BIRMINGHAM AL
35205-2610
US

V. Phone/Fax

Practice location:
  • Phone: 205-480-1889
  • Fax:
Mailing address:
  • Phone: 205-480-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1-134407
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: