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General NPI Number Information
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NPI Number | 1659478014
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Entity Type | Individual
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Provider Name | GLENN A HARRIS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 150 S INGLESIDE ST STE 4
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City | FAIRHOPE
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State | AL
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Zip | 36532-1804
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Country | US
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Telephone | 251-990-1920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 448
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City | WAYNESVILLE
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State | NC
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Zip | 28786-0448
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A68303
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2003029891
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 162439
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 162439
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License Number State | NC
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 200000225
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License Number State | NC
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