Harris, Charles Russell
Harris, Charles Russell is an individual health care provider with primary practice located at 101 Martin Luther King Jr Dr , Forsyth GA 31029-1698. He recently has 5 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Harris, Charles Russell can be contacted via phone (478) 994-5281.Contact Information
Primary practice address
101 Martin Luther King Jr Dr
Forsyth GA 31029-1698
Phone: (478) 994-5281
Fax: (478) 994-9781
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | 019692 | Georgia |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 019692 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | 019692 | Georgia |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 019692 | Georgia |
| Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | 019692 | Georgia |
Profile Details
| NPI number | 1073590410 |
|---|---|
| LBN Legal business name | Harris, Charles Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 28th, 2005 |
| Last updated | Apr 23rd, 2015 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073590410 | NPPES |
| Georgia | MEDICAID | 003136057 |
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