Healthcare Provider Details

I. General information

NPI: 1164527842
Provider Name (Legal Business Name): RONALD DENNIS HARTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 HOSPITAL LN
JELLICO TN
37762-4404
US

IV. Provider business mailing address

PO BOX 447
JELLICO TN
37762-0447
US

V. Phone/Fax

Practice location:
  • Phone: 423-784-7269
  • Fax: 423-784-3708
Mailing address:
  • Phone: 423-784-7269
  • Fax: 423-784-3708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD0000010924
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21799
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: