Provider Demographics
NPI:1902874571
Name:HARRIS, WILLIAM KEITH (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KEITH
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:7275 S SIWELL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39272-9776
Practice Address - Country:US
Practice Address - Phone:601-373-7722
Practice Address - Fax:601-373-7378
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5706626OtherAETNA
MS00119606Medicaid
MS753068151OtherMS HEALTH PARTNERS
MS00119606Medicaid
MS168390702OtherDEPT OF LABOR
MS753068151Other1ST CHOICE
MS5706626OtherAETNA
MS753068151008OtherTRICARE
MS753068151008OtherTRICARE
MS00119606Medicaid