Healthcare Provider Details

I. General information

NPI: 1902867468
Provider Name (Legal Business Name): ANTHONY MICHAEL HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N MANGOUSTINE AVE UNIT G
SANFORD FL
32771-1098
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 321-363-1754
  • Fax: 321-363-3336
Mailing address:
  • Phone:
  • Fax: 706-494-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME94420
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME94420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: