Diane Elise Harris, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

66500 Issued in GA

Practice address

4815 Oleander Dr
Wilmington, NC 28403-5108

Phone

(910) 452-1111

Fax

(910) 452-5897

NPI assigned

Jun 19, 2005

Sex

Female

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 3

Other names 1

• Diane Elise Ennis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

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

{
    "created_epoch": "1119139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334188800000",
    "number": "1396740940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 EXECUTIVE CIR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063345",
            "telephone_number": "912-691-1533",
            "fax_number": "912-691-1953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035108",
            "telephone_number": "910-452-1111",
            "fax_number": "910-452-5897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "DIANE",
        "middle_name": "ELISE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-19",
        "last_updated": "2012-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "66500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1396740940",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8939690",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0106F",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "ENNIS",
            "middle_name": "ELISE",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anne M Harris, DC
• Carter Winstead Harris
• Chante' D Harris
• Clyde L Harris, MD
• Dale Ainsley Harris
• James Alan Harris, M.D.
• Jennifer Harris, M.S., CCC-SLP
• Jennifer Nicole Harris, BS, MMP, LMBT
• John Joel Harris Jr., MD
• Kiersten Harris, OTR/L

• Family Medicine Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; 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.