Healthcare Provider Details

I. General information

NPI: 1033514302
Provider Name (Legal Business Name): HARTLEY HEALTH AND WELLNESS ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VILLAGE PROFESSIONAL DR STE 110
CANTON GA
30114-8499
US

IV. Provider business mailing address

207 CRESTMONT WAY
CANTON GA
30114-8875
US

V. Phone/Fax

Practice location:
  • Phone: 678-880-6698
  • Fax: 470-299-9936
Mailing address:
  • Phone: 147-021-0198
  • Fax: 147-077-7226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number11050778
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL RAY HARTLEY
Title or Position: OWNER
Credential:
Phone: 404-276-9043