Healthcare Provider Details

I. General information

NPI: 1255487252
Provider Name (Legal Business Name): JOHN DAVID HARRIS AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HARRISON ST SUITE C
BATESVILLE AR
72501-7442
US

IV. Provider business mailing address

2000 HARRISON ST SUITE C
BATESVILLE AR
72501-7442
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-6244
  • Fax: 870-793-5884
Mailing address:
  • Phone: 870-793-6244
  • Fax: 870-793-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA#205
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberA#205
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA#205
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: