Healthcare Provider Details

I. General information

NPI: 1326246190
Provider Name (Legal Business Name): THAD RIDGE HARDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 DAVE WARD DR STE 401
CONWAY AR
72034
US

IV. Provider business mailing address

2425 DAVE WARD DR STE 401
CONWAY AR
72034-8681
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3824
  • Fax:
Mailing address:
  • Phone: 501-329-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE5864
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: