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General NPI Number Information
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NPI Number | 1407875032
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Entity Type | Individual
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Provider Name | MICHAEL HARTLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 1109 BURLEYSON RD SUITE 202
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City | DALTON
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State | GA
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Zip | 30720-3094
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Country | US
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Telephone | 706-277-1573
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Fax | 706-370-7715
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Provider Business Mailing Address
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Address Line | 1109 BURLEYSON RD SUITE 202
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City | DALTON
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State | GA
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Zip | 30720-3094
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Country | US
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Telephone | 706-277-1573
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Fax | 706-370-7715
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL25878
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 63668
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License Number State | GA
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