Active NPI
Gavin Gibbs Harrell, DDS
- Dentist
- Elkin, NC
National Provider Identifier
1508871807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4488
- Practice address
- 834 Claremont Center Drive
Elkin, NC 28621 - Phone
- (336) 835-1212
- Fax
- (336) 835-3149
- NPI assigned
- Jul 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4488 | NC | Primary |
Addresses
Primary practice location
834 Claremont Center Drive
Elkin, NC 28621
Mailing address
834 Claremont Center Drive
Elkin, NC 28621
Phone (336) 835-1212
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 93568 | Other | NC | HEALTH CHOICE |
| 8993568 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4488 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508871807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "834 CLAREMONT CENTER DRIVE",
"city": "ELKIN",
"state": "NC",
"postal_code": "28621",
"telephone_number": "336-835-1212",
"fax_number": "336-835-3149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "834 CLAREMONT CENTER DRIVE",
"city": "ELKIN",
"state": "NC",
"postal_code": "28621",
"telephone_number": "336-835-1212",
"fax_number": "336-835-3149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRELL",
"first_name": "GAVIN",
"middle_name": "GIBBS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "4488",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH CHOICE",
"identifier": "93568",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8993568",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elkin, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.