Healthcare Provider Details

I. General information

NPI: 1033399274
Provider Name (Legal Business Name): MR. BOBBY EUGENE HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 EXCHANGE PL
GREENSBORO NC
27401-2608
US

IV. Provider business mailing address

6130 RED CEDAR DR APT 1 C
HIGH POINT NC
27265-7190
US

V. Phone/Fax

Practice location:
  • Phone: 336-442-4706
  • Fax: 336-275-8962
Mailing address:
  • Phone: 336-442-4706
  • Fax: 336-275-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: