Provider Demographics
NPI:1326872649
Name:HARRIS, ROY C III
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:C
Last Name:HARRIS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 MANCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-4406
Mailing Address - Country:US
Mailing Address - Phone:601-573-9075
Mailing Address - Fax:
Practice Address - Street 1:216 MANCHESTER DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-4406
Practice Address - Country:US
Practice Address - Phone:601-573-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle