Provider Demographics
NPI:1528242278
Name:HARRIS, TERRY
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S CAMBRIDGE CIR
Mailing Address - Street 2:SUITE 144
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27801-7444
Mailing Address - Country:US
Mailing Address - Phone:252-454-0404
Mailing Address - Fax:252-454-0405
Practice Address - Street 1:301 S CHURCH ST
Practice Address - Street 2:SUITE 144
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5755
Practice Address - Country:US
Practice Address - Phone:252-454-0404
Practice Address - Fax:252-454-0405
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3103251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408698Medicaid
NC6601330Medicaid