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NPI Code Detail

MEDICARE: WILLIAM HARELSON PA

MEDICARE: WILLIAM HARELSON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant939TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00030819OTHERTNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34064317OTHERTNBCBS OF TN

General Provider Information

NPI Number : 1205871761
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM HARELSON PA
Provider Business Mailing Address
First Line : 42 DOOLEY ST
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-4055
Country : US
Telephone Number : 931-707-7117
Fax Number : 888-456-7965
Provider Business Practice Location Address
First Line : 42 DOOLEY ST
Second Line :
City : CROSSVILLE
State : TN
Zip : 38555-4055
Country : US
Telephone Number : 931-707-7117
Fax Number : 888-456-7965
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 12/04/2014

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