Provider Demographics
NPI:1588844229
Name:HARRELL, LORI ANN MILLER (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN MILLER
Last Name:HARRELL
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:MILLER HARRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1120 15TH STREET, FA2030
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE, DIVISION OF HOSPITALI
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912
Mailing Address - Country:US
Mailing Address - Phone:706-721-6016
Mailing Address - Fax:706-721-7718
Practice Address - Street 1:2260 WRIGHTSBORO RD.
Practice Address - Street 2:TRINITY HOSPITAL
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-481-7391
Practice Address - Fax:706-481-7393
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN071579NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000967216AMedicaid
GA000967216AMedicaid