Provider Demographics
NPI:1750724167
Name:HARRELL, RYAN AUSTIN (DO)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:AUSTIN
Last Name:HARRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:910-721-4370
Mailing Address - Fax:910-721-4379
Practice Address - Street 1:6 DOCTORS CIR STE 5
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-6358
Practice Address - Country:US
Practice Address - Phone:910-721-4370
Practice Address - Fax:910-721-4379
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA92602207XX0005X
NC2023-02667207XX0005X, 207X00000X
VA0102205681207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine