Provider Demographics
NPI:1649284001
Name:HARRELL, JAMES A (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:A
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:805 SMITHBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1340
Mailing Address - Country:US
Mailing Address - Phone:229-244-8873
Mailing Address - Fax:229-482-5658
Practice Address - Street 1:852 W THIGPEN AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:GA
Practice Address - Zip Code:31635-1006
Practice Address - Country:US
Practice Address - Phone:229-482-8435
Practice Address - Fax:229-482-5658
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA026782207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93BDNDCMedicare ID - Type UnspecifiedMEDICARE
GAE19887Medicare UPIN