Provider Demographics
NPI:1700552288
Name:HARVILLE, JUDSON THOMAS
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:THOMAS
Last Name:HARVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MEDICAL CENTER PKWY STE 420
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3193
Mailing Address - Country:US
Mailing Address - Phone:615-229-5565
Mailing Address - Fax:
Practice Address - Street 1:1800 MEDICAL CENTER PKWY STE 420
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3193
Practice Address - Country:US
Practice Address - Phone:615-229-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29984363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner