Healthcare Provider Details

I. General information

NPI: 1013103100
Provider Name (Legal Business Name): WILLIAM HARRIS IV DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 HIGHWAY 9 BYP W
LANCASTER SC
29720-1709
US

IV. Provider business mailing address

1190 HIGHWAY 9 BYP W
LANCASTER SC
29720-1709
US

V. Phone/Fax

Practice location:
  • Phone: 803-804-5964
  • Fax: 803-283-9920
Mailing address:
  • Phone: 803-804-5964
  • Fax: 803-283-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number554
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005998
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number616
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: