Provider Demographics
NPI:1346744323
Name:HARRELL, JUSTIN MARK (DO STUDENT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MARK
Last Name:HARRELL
Suffix:
Gender:M
Credentials:DO STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-6602
Mailing Address - Country:US
Mailing Address - Phone:865-235-3303
Mailing Address - Fax:859-323-1197
Practice Address - Street 1:900 SOUTH LIMESTONE STREET SUITE 304
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-9918
Practice Address - Fax:859-323-1197
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN4808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program