Provider Demographics
NPI:1104076645
Name:HARRIS, ASHLEY WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:WAYNE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4905
Mailing Address - Country:US
Mailing Address - Phone:662-377-5930
Mailing Address - Fax:
Practice Address - Street 1:845 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4905
Practice Address - Country:US
Practice Address - Phone:662-377-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20408207QG0300X
MA242928207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine