Healthcare Provider Details

I. General information

NPI: 1275053167
Provider Name (Legal Business Name): REGINALD W HARRIS JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N BRIGHTLEAF BLVD
SMITHFIELD NC
27577-4407
US

IV. Provider business mailing address

625 GRANDE HEIGHTS DR
CARY NC
27513-3157
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-7189
  • Fax:
Mailing address:
  • Phone: 919-357-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2019-02451
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2019-02451
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019-02451
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: