Clyde L Harris, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

28415 Issued in NC

Practice address

2131 S 17TH St
Wilmington, NC 28401-7407

Phone

(910) 815-5830

Fax

(910) 815-5698

NPI assigned

Jul 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Smokey Mountain Healthcare Assoc PA

  • Family Medicine Physician
  • Franklin, NC
  • NPI 1528099421

  Internal Medicine

  NPD (past)
• Smoky Mountain Medical Associates, P.a.

  • Specialist
  • Franklin, NC
  • NPI 1740420702
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409011200000",
    "number": "1205855806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602484",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602484",
            "telephone_number": "910-815-5830",
            "fax_number": "910-815-5698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 S 17TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017407",
            "telephone_number": "910-815-5830",
            "fax_number": "910-815-5698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CLYDE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2014-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "28415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q28415",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8939871",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Harris Teeter, LLC
• Harris Teeter, LLC
• Anne M Harris, DC
• Carter Winstead Harris
• Chante' D Harris
• Dale Ainsley Harris
• Diane Elise Harris, D.O.
• James Alan Harris, M.D.
• Jennifer Harris, M.S., CCC-SLP
• Jennifer Nicole Harris, BS, MMP, LMBT

• All providers in Wilmington, NC
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.