Provider Demographics
NPI:1720604366
Name:HARRIS, SARAH A (AGAC NP-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AGAC NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 14611
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4611
Mailing Address - Country:US
Mailing Address - Phone:864-306-0966
Mailing Address - Fax:864-306-2544
Practice Address - Street 1:3523 PELHAM RD. CORPORATE OFFICE
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4191
Practice Address - Country:US
Practice Address - Phone:864-306-0966
Practice Address - Fax:864-306-2544
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23983363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC23983OtherSOUTH CAROLIINA LLR