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NPI Code Detail

MEDICARE: WILLIAM KEITH HARRIS MD

MEDICARE:   WILLIAM KEITH HARRIS  MD
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
1207Q00000XFamily Medicine Physician14932MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15706626OTHERMSAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902874571
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM KEITH HARRIS MD
Provider Business Mailing Address
First Line : 965 RIDGE LAKE BLVD STE 103
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-9446
Country : US
Telephone Number : 901-227-3255
Fax Number : 901-227-8591
Provider Business Practice Location Address
First Line : 7275 S SIWELL RD
Second Line :
City : JACKSON
State : MS
Zip : 39272-9776
Country : US
Telephone Number : 601-373-7722
Fax Number : 601-373-7378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2006
Last Update Date : 03/12/2018

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