Healthcare Provider Details

I. General information

NPI: 1750601357
Provider Name (Legal Business Name): CHARLES TOWNSEND HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE FL 6
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

1430 TULANE AVE # 8422
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5110
  • Fax: 504-988-0644
Mailing address:
  • Phone: 504-988-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number49211
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number310177
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number310177
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: