Healthcare Provider Details

I. General information

NPI: 1740283415
Provider Name (Legal Business Name): GARNET R HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MANOR DR
DANVILLE IN
46122
US

IV. Provider business mailing address

PO BOX 390
DANVILLE IN
46122
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-0044
  • Fax: 317-745-5219
Mailing address:
  • Phone: 317-718-0044
  • Fax: 317-745-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01029733
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: