Provider Demographics
NPI:1306879077
Name:HARLESS, RENEE RICE (MD)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:RICE
Last Name:HARLESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 GLENWOOD DRIVE
Mailing Address - Street 2:SUITE E-490
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1189
Mailing Address - Country:US
Mailing Address - Phone:423-624-8866
Mailing Address - Fax:423-591-8601
Practice Address - Street 1:725 GLENWOOD DRIVE
Practice Address - Street 2:SUITE E-490
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1189
Practice Address - Country:US
Practice Address - Phone:423-624-8866
Practice Address - Fax:423-591-8601
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN018396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031255Medicare ID - Type Unspecified
TNA99498Medicare UPIN