Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 53020 | MN |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD0000052128 | TN |
NPI | 1144451212 |
---|---|
Provider Name | Malinda N Harris |
First Address | Knoxville, TN 37916-2301 |
Second Address | Knoxville, TN 37916-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 24/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |
ENROLLED | (05) | SD |
ENROLLED | (05) | WI |