Healthcare Provider Details

I. General information

NPI: 1730528779
Provider Name (Legal Business Name): ABIGAIL LEAH HARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

802 N ELAM AVE
GREENSBORO NC
27408-6910
US

V. Phone/Fax

Practice location:
  • Phone: 336-207-7005
  • Fax:
Mailing address:
  • Phone: 336-253-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-04319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: