Healthcare Provider Details

I. General information

NPI: 1407119423
Provider Name (Legal Business Name): REBECCA M HART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CANAL ST STE 601
POOLER GA
31322-4087
US

IV. Provider business mailing address

130 CANAL ST STE 601
POOLER GA
31322-4087
US

V. Phone/Fax

Practice location:
  • Phone: 912-724-0955
  • Fax: 912-373-8058
Mailing address:
  • Phone: 912-724-0955
  • Fax: 912-373-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN198296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: