Provider Demographics
NPI:1427086909
Name:HARRIS, TRICIA-MAY VILLANUEVA (MD)
Entity type:Individual
Prefix:DR
First Name:TRICIA-MAY
Middle Name:VILLANUEVA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRICIA-MAY
Other - Middle Name:CALDERON
Other - Last Name:VILLANUEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1335 QUEENS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3790
Mailing Address - Country:US
Mailing Address - Phone:843-665-9958
Mailing Address - Fax:
Practice Address - Street 1:3651 WHEELER ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-651-2369
Practice Address - Fax:706-651-2364
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052313207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine