Healthcare Provider Details

I. General information

NPI: 1598747719
Provider Name (Legal Business Name): THOMAS G HARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HUGH DANIEL DR
BIRMINGHAM AL
35242-7145
US

IV. Provider business mailing address

2055 NORMANDIE DRIVE SUITE 108
MONTGOMERY AL
36111-2732
US

V. Phone/Fax

Practice location:
  • Phone: 205-995-4900
  • Fax: 205-995-0203
Mailing address:
  • Phone: 334-269-6337
  • Fax: 334-834-0657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number8894
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD8894
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: