Provider Demographics
NPI:1043251606
Name:HARRELL, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 ASHLAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-1067
Mailing Address - Country:US
Mailing Address - Phone:423-585-4348
Mailing Address - Fax:
Practice Address - Street 1:378 MARKETPLACE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2361
Practice Address - Country:US
Practice Address - Phone:423-282-0751
Practice Address - Fax:423-282-1577
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28241207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3804105Medicaid
TN3804105Medicaid
TNF94299Medicare UPIN
TN3804105Medicare ID - Type Unspecified