1649248105 NPI number — MR. BILLY HARMON PA

Table of content: MR. BILLY HARMON PA (NPI 1649248105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649248105 NPI number — MR. BILLY HARMON PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMON
Provider First Name:
BILLY
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649248105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1414 ELBA HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36079-6020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-670-6726
Provider Business Mailing Address Fax Number:
334-670-6731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 OATES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36352-4312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-299-3592
Provider Business Practice Location Address Fax Number:
334-299-3870
Provider Enumeration Date:
03/10/2006

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: 363A00000X , with the licence number:  PA.714 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 156199 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95001525 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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