Individual
HAROLD LANCE DEBORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
800 S MOHAWK DR STE E, ERWIN, TN 37650-2124
(423) 330-6177
(423) 330-6241
Mailing address
800 S MOHAWK DR STE E, ERWIN, TN 37650-2124
(423) 330-6177
(423) 330-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002182
VA
363A00000X
Physician Assistant
Primary
1316
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1503864
—
TN
Enumeration date
02/01/2006
Last updated
08/09/2022
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