Provider Demographics
NPI:1487974283
Name:HARRIS, KELLY CHO (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CHO
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7878
Mailing Address - Fax:615-920-8775
Practice Address - Street 1:114 GATEWAY CORPORATE BLVD STE 420
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9785
Practice Address - Country:US
Practice Address - Phone:803-365-8650
Practice Address - Fax:803-365-8659
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN52928208600000X
SC61254208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC612545Medicaid
TNQ013673Medicaid