Individual
STEPHEN L HARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 WEEMS ST, PURVIS, MS 39475-4062
(601) 794-2224
(601) 794-6392
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 794-2224
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10694
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117512
—
MS
05
—
1739782
—
LA
01
—
640507572MA
AMERICAN ADMIN GROUP
MS
Enumeration date
08/12/2006
Last updated
08/07/2020
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