Provider Demographics
NPI:1003835315
Name:HUNT-HARRISON, TYEHIMBA A (MD)
Entity Type:Individual
Prefix:
First Name:TYEHIMBA
Middle Name:A
Last Name:HUNT-HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VEAZEY DR
Mailing Address - Street 2:
Mailing Address - City:BUTNER
Mailing Address - State:NC
Mailing Address - Zip Code:27509-1668
Mailing Address - Country:US
Mailing Address - Phone:919-676-9699
Mailing Address - Fax:919-676-9946
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:SUITE 201
Practice Address - City:RALIEGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6653
Practice Address - Country:US
Practice Address - Phone:919-676-9699
Practice Address - Fax:919-676-9946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000008272084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI11604Medicare UPIN