Healthcare Provider Details

I. General information

NPI: 1669577003
Provider Name (Legal Business Name): ANGELA W. HARDY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY
AUGUSTA GA
30904-6285
US

IV. Provider business mailing address

1 FREEDOM WAY
AUGUSTA GA
30904-6285
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax:
Mailing address:
  • Phone: 706-733-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberR69196
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: