Provider Demographics
NPI:1871937326
Name:HARRIS, AMANDA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARRIS
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 1:2000 CHURCH ST
Mailing Address - Street 2:BOX 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37236-4400
Mailing Address - Country:US
Mailing Address - Phone:615-284-4672
Mailing Address - Fax:615-284-5752
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:BOX 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-4400
Practice Address - Country:US
Practice Address - Phone:615-284-4672
Practice Address - Fax:615-284-5752
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54054207R00000X
390200000X
IA48803208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021341Medicaid
TN103I114467Medicare PIN