Healthcare Provider Details

I. General information

NPI: 1083523468
Provider Name (Legal Business Name): ANETRA HART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 STE. L PMB 1022 HILLCREST PWKY
DUBLIN GA
31021
US

IV. Provider business mailing address

1101 STE. L PMB 1022 HILLCREST PWKY
DUBLIN GA
31021
US

V. Phone/Fax

Practice location:
  • Phone: 478-800-3524
  • Fax: 478-202-9544
Mailing address:
  • Phone: 478-800-3524
  • Fax: 478-202-9544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: