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General NPI Number Information
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NPI Number | 1881214815
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Entity Type | Individual
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Provider Name | JUSTIN P HARRELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2020
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 4343 W NEWBERRY RD
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City | GAINESVILLE
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State | FL
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Zip | 32607-2817
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Country | US
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Telephone | 352-372-8202
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Fax | 352-375-6888
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Provider Business Mailing Address
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Address Line | 4881 NW 8TH AVE SUITE 2
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City | GAINESVILLE
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State | FL
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Zip | 32605-4582
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Country | US
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Telephone | 352-416-1082
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Fax | 352-373-6144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME169164
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME169164
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License Number State | FL
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