MEDICARE: KAMI HARRIS

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
1	2084P0802X	Addiction Psychiatry Physician	001007973	NC
2	363A00000X	Physician Assistant	0010-07973	NC

General Provider Information

NPI Number	:	1134625643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMI HARRIS

Provider Business Mailing Address
First Line	:	7826 SPUNGOLD ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-8603
Country	:	US
Telephone Number	:	919-561-9391
Fax Number	:

Provider Business Practice Location Address
First Line	:	7826 SPUNGOLD ST
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-8603
Country	:	US
Telephone Number	:	919-561-9391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	09/17/2019

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Directions to “ KAMI HARRIS ” Practice Location

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