Basic Information
| Provider Information | |||||||||
| NPI: | 1750724167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRELL | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | AUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HOWARD FARM DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300416081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702926500 | ||||||||
| FaxNumber: | 7702926535 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 HOWARD FARM DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300416081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702926500 | ||||||||
| FaxNumber: | 7702926535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2013 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 0102205681 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 92602 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.