Healthcare Provider Details

I. General information

NPI: 1720799398
Provider Name (Legal Business Name): JAMES HARTGRAVES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W RANDOL MILL RD STE 120
ARLINGTON TX
76012-2579
US

IV. Provider business mailing address

4700 SETON CENTER PKWY STE 115
AUSTIN TX
78759-5753
US

V. Phone/Fax

Practice location:
  • Phone: 817-801-1503
  • Fax: 817-801-1508
Mailing address:
  • Phone: 346-440-0645
  • Fax: 346-478-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA16587
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: