Provider Demographics
NPI:1821320888
Name:HARRELL, KATHERINE DONOVAN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DONOVAN
Last Name:HARRELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ALANNA
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-854-6008
Mailing Address - Fax:706-854-6946
Practice Address - Street 1:820 SAINT SEBASTIAN WAY STE 4A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2643
Practice Address - Country:US
Practice Address - Phone:706-774-5995
Practice Address - Fax:706-774-5996
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005758363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA301392981CMedicaid
GA301392981BMedicaid
GA301392981AMedicaid
GA301392981DMedicaid
GA301392981DMedicaid