Provider Demographics
NPI:1407254022
Name:HARRELL, ROY LEE JR (NP)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:LEE
Last Name:HARRELL
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 WHITEOAK DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:415 ARMOUR DR NE
Practice Address - Street 2:#10303
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3933
Practice Address - Country:US
Practice Address - Phone:404-849-1611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018034790363LP0808X
GARN174455363LF0000X, 363LP0808X
MN5881363LP0808X
OR201803616NP-PP363LP0808X
WAAP60851716363LP0808X
WI8415-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily