Healthcare Provider Details

I. General information

NPI: 1356258065
Provider Name (Legal Business Name): MICHAEL E HARDIN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SEQUOIA DR
CHATTANOOGA TN
37411-5417
US

IV. Provider business mailing address

125 SEQUOIA DR
CHATTANOOGA TN
37411-5417
US

V. Phone/Fax

Practice location:
  • Phone: 423-544-1025
  • Fax:
Mailing address:
  • Phone: 423-509-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number104499
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: