Basic Information
| Provider Information | |||||||||
| NPI: | 1629175575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLAM | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | RUSSELL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW MASTER SOCIAL W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 914 SUTTON HILL ROAD | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153851604 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1310 24TH AVE SOUTH | ||||||||
| Address2: | DEPT OF VETERANS AFFAIRS HOSPITAL | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153275320 | ||||||||
| FaxNumber: | 6153216353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 104100000X | 4327269 | TN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.