Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 16635 | SC |
N | 208D00000X | General Practice Physician | 16635 | SC |
NPI | 1114092897 |
---|---|
Provider Name | Craig Dyer Harris |
First Address | Summerville, SC 29483 |
Second Address | Summerville, SC 29483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |