Basic Information
| Provider Information | |||||||||
| NPI: | 1598747719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRELL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 NORMANDIE DRIVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342696337 | ||||||||
| FaxNumber: | 3348340657 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 HUGH DANIEL DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352427145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059954900 | ||||||||
| FaxNumber: | 2059950203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 10/24/2016 | ||||||||
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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 | 2085R0202X | 8894 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD8894 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 009901155 | 05 | AL | MEDICAID | 470000833 | 01 | GA | TRAVELERS RR M/C MONTCLAI | OTHER | 51000185 | 01 | AL | BC SYLACAUGA | OTHER | 51511245 | 01 | AL | BC 280 | OTHER | 009934112 | 05 | AL | MEDICAID | 470001757 | 01 | GA | TRAVELERS RR M/C SHELBY | OTHER | 51510473 | 01 | AL | BC GREYSTONE | OTHER | 009919955 | 05 | AL | MEDICAID | 470001761 | 01 | GA | TRAVELERS RR M/C 280 | OTHER | 51511246 | 01 | AL | BC MONTCLAIR | OTHER | 009901165 | 05 | AL | MEDICAID | 009908845 | 05 | AL | MEDICAID | 51510475 | 01 | AL | BC SHELBY | OTHER | P00206200 | 01 | GA | TRAVELERS RR M/C SYLACAUG | OTHER | 470000666 | 01 | GA | TRAVELERS RR M/C GREYSTON | OTHER |