Basic Information
| Provider Information | |||||||||
| NPI: | 1902821804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARVEY | ||||||||
| FirstName: | ROY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1343 CANTON RD | ||||||||
| Address2: | STE C | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300666079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662148600 | ||||||||
| FaxNumber: | 6788880390 | ||||||||
| Practice Location | |||||||||
| Address1: | 1304 W BOBO NEWSOM HWY | ||||||||
| Address2: | |||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295504710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662148600 | ||||||||
| FaxNumber: | 6788880390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/27/2016 | ||||||||
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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 | 367500000X | ANP19663 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 009954880 | 05 | AL | MEDICAID | 051502638 | 01 | AL | BLUECROSS | OTHER |