Provider Demographics
NPI:1902300874
Name:HARALSON, HATTIE LEE
Entity Type:Individual
Prefix:
First Name:HATTIE
Middle Name:LEE
Last Name:HARALSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 CAMPBELL ROAD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MS
Mailing Address - Zip Code:39039
Mailing Address - Country:US
Mailing Address - Phone:662-571-9302
Mailing Address - Fax:
Practice Address - Street 1:3825 CAMPBELL ROAD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MS
Practice Address - Zip Code:39039
Practice Address - Country:US
Practice Address - Phone:662-571-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker