Healthcare Provider Details

I. General information

NPI: 1588039069
Provider Name (Legal Business Name): BRANDON L. HARDY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 UNION POINT ST
LEXINGTON GA
30648
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 706-743-8171
  • Fax:
Mailing address:
  • Phone: 67-883-2347
  • Fax: 706-788-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006339
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: