Healthcare Provider Details

I. General information

NPI: 1154306587
Provider Name (Legal Business Name): ERICA LYN HARTMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW BLDG 77 5TH FLOOR
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1968 PEACHTREE RD NW BLDG 77 5TH FLOOR
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-4602
  • Fax: 404-367-4447
Mailing address:
  • Phone: 404-605-4602
  • Fax: 404-367-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number200300045
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number064558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: