Healthcare Provider Details

I. General information

NPI: 1578504114
Provider Name (Legal Business Name): REGINA B HARRELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 5TH AVE E
TUSCALOOSA AL
35401-7419
US

IV. Provider business mailing address

850 5TH AVE E
TUSCALOOSA AL
35401-7419
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-1770
  • Fax: 205-348-2889
Mailing address:
  • Phone: 205-348-1770
  • Fax: 205-348-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number200400351
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD.27429
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: