Individual
DIANE ELISE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4815 OLEANDER DR, WILMINGTON, NC 28403-5108
(910) 452-1111
(910) 452-5897
Mailing address
5 EXECUTIVE CIR, SAVANNAH, GA 31406-3345
(912) 691-1533
(912) 691-1953
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
66500
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106F
BLUE CROSS BLUE SHIELD
NC
01
—
1396740940
NPI
NC
05
—
8939690
—
NC
Enumeration date
06/19/2005
Last updated
04/12/2012
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