Provider Demographics
NPI:1598747719
Name:HARRELL, THOMAS G (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2055 NORMANDIE DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-269-6337
Mailing Address - Fax:334-834-0657
Practice Address - Street 1:7500 HUGH DANIEL DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7145
Practice Address - Country:US
Practice Address - Phone:205-995-4900
Practice Address - Fax:205-995-0203
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL88942085R0202X
ALMD88942085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009901155Medicaid
GA470000833OtherTRAVELERS RR M/C MONTCLAI
AL51000185OtherBC SYLACAUGA
AL51511245OtherBC 280
AL009934112Medicaid
GA470001757OtherTRAVELERS RR M/C SHELBY
AL51510473OtherBC GREYSTONE
AL009919955Medicaid
GA470001761OtherTRAVELERS RR M/C 280
AL51511246OtherBC MONTCLAIR
AL009901165Medicaid
AL009908845Medicaid
AL51510475OtherBC SHELBY
GAP00206200OtherTRAVELERS RR M/C SYLACAUG
GA470000666OtherTRAVELERS RR M/C GREYSTON
GA470000666OtherTRAVELERS RR M/C GREYSTON
AL51511246OtherBC MONTCLAIR
AL009901155Medicaid