Healthcare Provider Details

I. General information

NPI: 1114801792
Provider Name (Legal Business Name): JODY HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SOUTHSHORE DR
GREENBACK TN
37742-2301
US

IV. Provider business mailing address

309 SOUTHSHORE DR
GREENBACK TN
37742-2301
US

V. Phone/Fax

Practice location:
  • Phone: 865-851-5764
  • Fax:
Mailing address:
  • Phone: 865-340-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: