Provider Demographics
NPI:1902821804
Name:HARVEY, ROY (CRNA)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 CANTON RD
Mailing Address - Street 2:STE C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6079
Mailing Address - Country:US
Mailing Address - Phone:866-214-8600
Mailing Address - Fax:678-888-0390
Practice Address - Street 1:1304 W BOBO NEWSOM HWY
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4710
Practice Address - Country:US
Practice Address - Phone:866-214-8600
Practice Address - Fax:678-888-0390
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCANP19663367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009954880Medicaid
AL051502638OtherBLUECROSS
AL051502638OtherBLUECROSS
ALS94835Medicare UPIN