MEDICARE: MR. ROY LEE HARRELL JR. NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2018034790	MO
2	363LF0000X	Family Nurse Practitioner	RN174455	GA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5881	MN
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	201803616NP-PP	OR
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60851716	WA
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	8415-33	WI
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN174455	GA

General Provider Information

NPI Number	:	1407254022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROY LEE HARRELL JR. NP

Provider Business Mailing Address
First Line	:	2292 WHITEOAK DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 ARMOUR DR NE
Second Line	:	#10303
City	:	ATLANTA
State	:	GA
Zip	:	30324-3933
Country	:	US
Telephone Number	:	404-849-1611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2014
Last Update Date	:	05/08/2019

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