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General NPI Number Information
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NPI Number | 1124027685
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Entity Type | Individual
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Provider Name | MARK ALAN HARTLEY MPAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 7950 MARTIN LOOP MARTIN ARMY COMMUNITY HOSPITAL
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City | FORT BENNING
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State | GA
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Zip | 31905-5647
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Country | US
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Telephone | 706-545-8543
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Fax |
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Provider Business Mailing Address
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Address Line | 1063 LEE ROAD 338
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City | SALEM
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State | AL
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Zip | 36874-1219
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Country | US
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Telephone | 706-761-8293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1033608
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License Number State | GA
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