=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083113880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA FREEMAN HARRIS PA - C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2018
-----------------------------------------------------
Last Update Date | 04/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6503 BREVARD RD
-----------------------------------------------------
City | ETOWAH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28729-8739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-890-4156
-----------------------------------------------------
Fax | 828-891-9276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 N JUSTICE ST # 16
-----------------------------------------------------
City | HENDERSONVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28791-3410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-694-8385
-----------------------------------------------------
Fax | 828-694-7654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0010-07907
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------