Healthcare Provider Details

I. General information

NPI: 1174597652
Provider Name (Legal Business Name): SENETA L HARDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 RIDGE AVE SW
ATLANTA GA
30315-1640
US

IV. Provider business mailing address

1046 RIDGE AVE SW
ATLANTA GA
30315-1640
US

V. Phone/Fax

Practice location:
  • Phone: 404-688-1350
  • Fax: 404-564-6734
Mailing address:
  • Phone: 404-688-1350
  • Fax: 404-564-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number052443
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: