Healthcare Provider Details

I. General information

NPI: 1356870265
Provider Name (Legal Business Name): JAMES B HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12077 GAYTON RD
RICHMOND VA
23238-3401
US

IV. Provider business mailing address

6372 MECHANICSVILLE TPKE STE 105
MECHANICSVILLE VA
23111-4705
US

V. Phone/Fax

Practice location:
  • Phone: 804-359-5851
  • Fax:
Mailing address:
  • Phone: 804-559-4625
  • Fax: 804-559-4627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2101001801
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: