Provider Demographics
NPI:1588052096
Name:CHARLES HARRIS PHD PLLC
Entity type:Organization
Organization Name:CHARLES HARRIS PHD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:22887-576-4827
Mailing Address - Street 1:1217 NELSON DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3032
Mailing Address - Country:US
Mailing Address - Phone:228-875-7648
Mailing Address - Fax:
Practice Address - Street 1:1217 NELSON DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3032
Practice Address - Country:US
Practice Address - Phone:228-875-7648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS36-620283Q00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS36-620OtherPSYCHOLOGIST LICENSE NUMBER
MS680000286OtherMEDICARE IDENTIFICAQTION NUMBER