Healthcare Provider Details

I. General information

NPI: 1457468837
Provider Name (Legal Business Name): DAVID J. HARRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7714 CONNER RD STE 103
POWELL TN
37849-3559
US

IV. Provider business mailing address

PO BOX 52948
KNOXVILLE TN
37950-2948
US

V. Phone/Fax

Practice location:
  • Phone: 865-938-8121
  • Fax: 865-212-5561
Mailing address:
  • Phone: 865-306-5675
  • Fax: 865-584-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number29357
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD 29357
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: