Healthcare Provider Details

I. General information

NPI: 1396938239
Provider Name (Legal Business Name): JOHN J HARRIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE SUITE 618
MEMPHIS TN
38157-0618
US

IV. Provider business mailing address

5050 POPLAR AVE SUITE 618
MEMPHIS TN
38157-0618
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 TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number004915
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04915
License Number StateTN

VIII. Authorized Official

Name: DONNA CARSON
Title or Position: SECRETARY
Credential:
Phone: 901-682-3035