Healthcare Provider Details

I. General information

NPI: 1700220977
Provider Name (Legal Business Name): LISA KATHERINE HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA KATHERINE MORRIS

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOMANS WAY
BATON ROUGE LA
70817-5100
US

IV. Provider business mailing address

8230 SUMMA AVE STE C
BATON ROUGE LA
70809-3465
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-0552
  • Fax: 225-763-9997
Mailing address:
  • Phone: 225-757-0552
  • Fax: 225-763-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number311482
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number31627
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number63769
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number88533
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: