1588844229 NPI number — MRS. LORI ANN MILLER HARRELL APRN, BC

Table of content: (NPI 1861428336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588844229 NPI number — MRS. LORI ANN MILLER HARRELL APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRELL
Provider First Name:
LORI
Provider Middle Name:
ANN MILLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER HARRELL
Provider Other First Name:
LORI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588844229
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 15TH STREET, FA2030
Provider Second Line Business Mailing Address:
DEPARTMENT OF EMERGENCY MEDICINE, DIVISION OF HOSPITALI
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-721-6016
Provider Business Mailing Address Fax Number:
706-721-7718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2260 WRIGHTSBORO RD.
Provider Second Line Business Practice Location Address:
TRINITY HOSPITAL
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-481-7391
Provider Business Practice Location Address Fax Number:
706-481-7393
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN071579NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000967216A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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