Healthcare Provider Details

I. General information

NPI: 1023164225
Provider Name (Legal Business Name): DAVID P. HARTLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E CENTER ST
CARROLLTON GA
30117-3303
US

IV. Provider business mailing address

106 E CENTER ST
CARROLLTON GA
30117-3303
US

V. Phone/Fax

Practice location:
  • Phone: 770-830-6006
  • Fax:
Mailing address:
  • Phone: 770-830-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number033349
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: