Healthcare Provider Details

I. General information

NPI: 1992863864
Provider Name (Legal Business Name): JOHN J HARRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE SUITE 618
MEMPHIS TN
38157-0101
US

IV. Provider business mailing address

5050 POPLAR AVE SUITE 618
MEMPHIS TN
38157-0101
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-3035
  • Fax: 901-682-3049
Mailing address:
  • Phone: 901-682-3035
  • Fax: 901-682-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberTN04915
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: