Provider Demographics
NPI:1881698561
Name:HARKLEROAD, ALFRED (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:HARKLEROAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:240 MEDICAL PARK BLVD
Practice Address - Street 2:STE 3800
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7351
Practice Address - Country:US
Practice Address - Phone:423-990-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 12818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3189597Medicaid
VA005618509Medicaid
VAC06181Medicaid
VAMC10359Medicare PIN
VAC06181Medicaid
0281780001Medicare PIN
0281780003Medicare PIN
TN3189595Medicare ID - Type Unspecified
TN3189597Medicaid
B04387Medicare UPIN
TN080089273Medicare PIN