Healthcare Provider Details

I. General information

NPI: 1215134978
Provider Name (Legal Business Name): JEFFREY DEAN HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 MILESTONE WAY
GREENVILLE SC
29615-5065
US

IV. Provider business mailing address

142 MILESTONE WAY
GREENVILLE SC
29615-5065
US

V. Phone/Fax

Practice location:
  • Phone: 864-558-0092
  • Fax: 855-269-6611
Mailing address:
  • Phone: 864-558-0092
  • Fax: 855-269-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30517
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: