Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 48578 | TN |
Y | 2080P0214X | Pediatric Pulmonologist | 48578 | TN |
NPI | 1114161098 |
---|---|
Provider Name | Atia Jordan Harris |
First Address | Memphis, TN 38105-4607 |
Second Address | Memphis, TN 38105-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2009 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00334251 | (05) | MS |
1532546 | (05) | TN |
217905001 | (05) | AR |
48578 | TN MEDICAL LICENSE (01) | TN |