Basic Information
| Provider Information | |||||||||
| NPI: | 1871518860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11565 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374012565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237785445 | ||||||||
| FaxNumber: | 4237783157 | ||||||||
| Practice Location | |||||||||
| Address1: | 5195 BATTLEFIELD PKWY | ||||||||
| Address2: | |||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307365148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7069379292 | ||||||||
| FaxNumber: | 7069377207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36621 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.