Healthcare Provider Details

I. General information

NPI: 1437180957
Provider Name (Legal Business Name): DEBORAH I HANSARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 ALABAMA AVE
BREMEN GA
30110-2005
US

IV. Provider business mailing address

132 OLE HICKORY TRAIL
CARROLLTON GA
30117
US

V. Phone/Fax

Practice location:
  • Phone: 770-537-2367
  • Fax: 770-537-1203
Mailing address:
  • Phone: 770-830-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number023292
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: