Provider Demographics
NPI:1205871761
Name:HARELSON, WILLIAM (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HARELSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 DOOLEY ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4055
Mailing Address - Country:US
Mailing Address - Phone:931-707-7117
Mailing Address - Fax:888-456-7965
Practice Address - Street 1:42 DOOLEY ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4055
Practice Address - Country:US
Practice Address - Phone:931-707-7117
Practice Address - Fax:888-456-7965
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00030819OtherRAILROAD MEDICARE
TN1508389Medicaid
TN4064317OtherBCBS OF TN
TNP00030819OtherRAILROAD MEDICARE
TN4064317OtherBCBS OF TN