Healthcare Provider Details

I. General information

NPI: 1740475052
Provider Name (Legal Business Name): HARDCHOICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2583 S VOLUSIA AVE STE 200
ORANGE CITY FL
32763-9129
US

IV. Provider business mailing address

1895 PHOENIX BLVD SUITE 338
COLLEGE PARK GA
30349-5592
US

V. Phone/Fax

Practice location:
  • Phone: 386-960-7830
  • Fax: 386-960-7833
Mailing address:
  • Phone: 678-604-0891
  • Fax: 678-604-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME-122760
License Number State

VIII. Authorized Official

Name: DR. JAMES LEWIS FENLEY JR.
Title or Position: OWNER
Credential: MD
Phone: 386-960-7830