=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588052096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES HARRIS PHD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2015
-----------------------------------------------------
Last Update Date | 01/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1217 NELSON DR
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-3032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-875-7648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1217 NELSON DR
-----------------------------------------------------
City | OCEAN SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39564-3032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-875-7648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OFFICER
-----------------------------------------------------
Name | DR. CHARLES EUGENE HARRIS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 228875764827
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 36-620
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 36-620
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------