Individual
SHIRLEY LAVON HARRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1101 OCILLA RD, DOUGLAS, GA 31533-2207
(912) 384-1900
(912) 389-2112
Mailing address
PO BOX 1227, DOUGLAS, GA 31534-1227
(912) 384-1900
(912) 389-2112
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
RN056220
GA
363L00000X
Nurse Practitioner
Primary
RN056220
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804987669A
—
GA
05
—
804987669B
—
GA
Enumeration date
02/13/2006
Last updated
06/24/2021
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