Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 20408 | MS |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 242928 | MA |
NPI | 1104076645 |
---|---|
Provider Name | Dr. Ashley Wayne Harris |
First Address | Tupelo, MS 38801-4905 |
Second Address | Tupelo, MS 38801-4905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2008 |
Last Update Date | 10/02/2012 |