Provider Demographics
NPI:1992717524
Name:HARRIS, DENNIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 NASH ST NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1735
Mailing Address - Country:US
Mailing Address - Phone:252-237-8403
Mailing Address - Fax:252-237-7443
Practice Address - Street 1:2261 NASH ST NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1735
Practice Address - Country:US
Practice Address - Phone:252-237-8403
Practice Address - Fax:252-237-7443
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant