Individual
LARRY GENE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2145 HENRY TECKLENBURG DR STE 220, CHARLESTON, SC 29414-5894
(843) 723-8823
(843) 606-8059
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
A751
SC
363AS0400X
Surgical Physician Assistant
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0058PA
—
SC
Enumeration date
06/29/2006
Last updated
12/13/2019
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