Healthcare Provider Details

I. General information

NPI: 1902818495
Provider Name (Legal Business Name): CHRISTINA R HARDWICK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BLACK RIVER RD STE 300
GEORGETOWN SC
29440-3304
US

IV. Provider business mailing address

6626 E. 75TH STREET SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 843-652-8290
  • Fax:
Mailing address:
  • Phone: 317-497-1920
  • Fax: 317-497-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000573
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: