Healthcare Provider Details

I. General information

NPI: 1497012751
Provider Name (Legal Business Name): MICHAEL JONATHAN HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 01/02/2025
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK STE 107
RALEIGH NC
27615-4731
US

IV. Provider business mailing address

PO BOX 604337
CHARLOTTE NC
28260-4337
US

V. Phone/Fax

Practice location:
  • Phone: 919-238-2000
  • Fax: 919-238-5010
Mailing address:
  • Phone: 919-238-2000
  • Fax: 919-238-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2014-01894
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2014-01894
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: