Healthcare Provider Details

I. General information

NPI: 1679769491
Provider Name (Legal Business Name): ALLEN MCNEIL HARAWAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2007
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N STATE ST SUITE 400
JACKSON MS
39202-1658
US

IV. Provider business mailing address

1421 N STATE ST SUITE 400
JACKSON MS
39202-1658
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-9900
  • Fax:
Mailing address:
  • Phone: 601-353-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301095875
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number20832
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: