Healthcare Provider Details

I. General information

NPI: 1821006008
Provider Name (Legal Business Name): CALVIN JEROME HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GOVERNORS DR. SE VA MENTAL HEALTH CLINIC
HUNTSVILLE AL
35801
US

IV. Provider business mailing address

3405 PINEHURST DR SW
DECATUR AL
35603-1257
US

V. Phone/Fax

Practice location:
  • Phone: 256-535-3100
  • Fax:
Mailing address:
  • Phone: 256-350-4498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16174
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: