Healthcare Provider Details

I. General information

NPI: 1013374503
Provider Name (Legal Business Name): AARON C. HARRIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HOSPITAL DR SUITE 130
JEFFERSON CITY TN
37760-5287
US

IV. Provider business mailing address

1225 E WEISGARBER RD SUITE 200
KNOXVILLE TN
37909-2604
US

V. Phone/Fax

Practice location:
  • Phone: 865-474-4742
  • Fax: 865-262-0100
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-584-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2984
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: