Individual
DR. CHARLES RUSSELL HARRIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 MARTIN LUTHER KING JR DR, FORSYTH, GA 31029-1698
(478) 994-5281
(478) 994-9781
Mailing address
2400 BELLEVUE RD, SUITE 21-A, DUBLIN, GA 31021-2885
(478) 275-7202
(478) 274-8418
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
019692
GA
207ND0900X
Dermatopathology Physician
019692
GA
207NP0225X
Pediatric Dermatology Physician
019692
GA
207NS0135X
Procedural Dermatology Physician
019692
GA
208D00000X
General Practice Physician
019692
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136057
—
GA
Enumeration date
12/28/2005
Last updated
04/23/2015
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