Basic Information
| Provider Information | |||||||||
| NPI: | 1457468837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52948 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379502948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653065675 | ||||||||
| FaxNumber: | 8655847712 | ||||||||
| Practice Location | |||||||||
| Address1: | 7714 CONNER RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | POWELL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378493559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659388121 | ||||||||
| FaxNumber: | 8652125561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 29357 | TN | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | MD 29357 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3811775 | 05 | TN | MEDICAID |