Basic Information
Provider Information
NPI: 1821062951
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARRIS
FirstName: JAMES
MiddleName: MERRIMON
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 68
Address2:  
City: POLLOCKSVILLE
State: NC
PostalCode: 285730068
CountryCode: US
TelephoneNumber: 2523939007
FaxNumber: 2523939921
Practice Location
Address1: 906 WB MCLEAN BLVD
Address2:  
City: CAPE CARTERET
State: NC
PostalCode: 285849211
CountryCode: US
TelephoneNumber: 2523939007
FaxNumber: 2523939921
Other Information
ProviderEnumerationDate: 02/15/2006
LastUpdateDate: 04/26/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X9800266NCY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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