Individual
DR. GLENN A HARRIS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 S INGLESIDE ST STE 4, FAIRHOPE, AL 36532-1804
(251) 990-1920
Mailing address
PO BOX 448, WAYNESVILLE, NC 28786-0448
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
200000225
NC
174400000X
Specialist
2003029891
MO
174400000X
Specialist
A68303
CA
207R00000X
Internal Medicine Physician
162439
NC
207RC0000X
Cardiovascular Disease Physician
162439
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5900317
—
NC
Enumeration date
09/20/2006
Last updated
03/23/2022
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