Provider Demographics
NPI:1487261087
Name:HARRELSON, WILLIAM ANDREW
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANDREW
Last Name:HARRELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 UNION LINE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-0772
Mailing Address - Country:US
Mailing Address - Phone:601-323-6943
Mailing Address - Fax:
Practice Address - Street 1:215 UNION LINE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39443-0772
Practice Address - Country:US
Practice Address - Phone:601-323-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program