Provider Demographics
NPI:1528100948
Name:HARLESS, WILLIAM W (MD PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:HARLESS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 AFFLINK PL STE 101
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2289
Mailing Address - Country:US
Mailing Address - Phone:205-366-9740
Mailing Address - Fax:205-344-9992
Practice Address - Street 1:3415 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1334
Practice Address - Country:US
Practice Address - Phone:304-388-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37144174400000X
MEMD23392207RX0202X
CT62961207RX0202X
WV21423207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH33097Medicare UPIN