Provider Demographics
NPI:1447884101
Name:HARSHAW, EMILY CAROLINE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CAROLINE
Last Name:HARSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:110 KILDAIRE PARK DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8162
Practice Address - Country:US
Practice Address - Phone:919-235-0616
Practice Address - Fax:919-235-0610
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8017363A00000X
NC0010-14040363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447884101Medicaid