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NPI Code Detail

MEDICARE: MARK HAMPTON HARRIS PA-C

MEDICARE: MARK HAMPTON HARRIS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician101659NC
2363A00000XPhysician Assistant101659NC
3363AM0700XMedical Physician Assistant101659NC

General Provider Information

NPI Number : 1134189517
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK HAMPTON HARRIS PA-C
Provider Business Mailing Address
First Line : 2654 VIENNA DOZIER RD
Second Line :
City : PFAFFTOWN
State : NC
Zip : 27040-8457
Country : US
Telephone Number : 336-945-4130
Fax Number : 336-945-4130
Provider Business Practice Location Address
First Line : 180 PARKWOOD DR
Second Line :
City : ELKIN
State : NC
Zip : 28621-2430
Country : US
Telephone Number : 336-527-7472
Fax Number : 336-835-8752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 10/29/2020

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