Healthcare Provider Details

I. General information

NPI: 1982641189
Provider Name (Legal Business Name): ROBERT LOVE HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/11/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 RIVER OAKS SR. SUITE 103
FLOWOOD MS
39232-7696
US

IV. Provider business mailing address

501 MARSHALL ST SUITE 600
JACKSON MS
39202-1651
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-6540
  • Fax: 601-948-6518
Mailing address:
  • Phone: 601-948-6540
  • Fax: 601-326-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number00016908
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number12843
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number00016908
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12843
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: