Provider Demographics
NPI:1104575091
Name:GHAYUR, HARIS (MD)
Entity type:Individual
Prefix:
First Name:HARIS
Middle Name:
Last Name:GHAYUR
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 1:2841 CHERRY BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3843
Mailing Address - Country:US
Mailing Address - Phone:512-745-7879
Mailing Address - Fax:
Practice Address - Street 1:2401 PARMAN PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1518
Practice Address - Country:US
Practice Address - Phone:512-745-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN718412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry