Provider Demographics
NPI:1174517189
Name:HARRILL, WILLARD C (MD)
Entity type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:C
Last Name:HARRILL
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 1:304 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3834
Mailing Address - Country:US
Mailing Address - Phone:828-322-2183
Mailing Address - Fax:828-328-2838
Practice Address - Street 1:304 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3834
Practice Address - Country:US
Practice Address - Phone:828-322-2183
Practice Address - Fax:828-328-2838
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601626207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891134QMedicaid
G69114Medicare UPIN
2246228AMedicare ID - Type Unspecified