1427086909 NPI number — DR. TRICIA-MAY VILLANUEVA HARRIS M.D.

Table of content: DR. TRICIA-MAY VILLANUEVA HARRIS M.D. (NPI 1427086909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427086909 NPI number — DR. TRICIA-MAY VILLANUEVA HARRIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
TRICIA-MAY
Provider Middle Name:
VILLANUEVA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLANUEVA
Provider Other First Name:
TRICIA-MAY
Provider Other Middle Name:
CALDERON
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427086909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1335 QUEENS FERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29505-3790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-665-9958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3651 WHEELER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-651-2369
Provider Business Practice Location Address Fax Number:
706-651-2364
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  052313 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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