Provider Demographics
NPI:1780863555
Name:JIM A. HARRELL, JR., D.D.S., PA
Entity Type:Organization
Organization Name:JIM A. HARRELL, JR., D.D.S., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL FAMILY DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-835-3337
Mailing Address - Street 1:835 CLAREMONT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2488
Mailing Address - Country:US
Mailing Address - Phone:336-835-3337
Mailing Address - Fax:336-835-1241
Practice Address - Street 1:835 CLAREMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2488
Practice Address - Country:US
Practice Address - Phone:336-835-3337
Practice Address - Fax:336-835-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty