Provider Demographics
NPI:1992556690
Name:HARRIS, SAMUEL G
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:G
Last Name:HARRIS
Suffix:
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 1:1613 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6109
Mailing Address - Country:US
Mailing Address - Phone:206-523-4663
Mailing Address - Fax:
Practice Address - Street 1:1613 N 52ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6109
Practice Address - Country:US
Practice Address - Phone:206-523-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator