Healthcare Provider Details

I. General information

NPI: 1992720908
Provider Name (Legal Business Name): JAMES TODD HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 BLUE RIDGE RD SUITE 401
RALEIGH NC
27607-6478
US

IV. Provider business mailing address

3304 TALL TREE PL
RALEIGH NC
27607-6669
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-7490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number96-00937
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: