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General NPI Number Information
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NPI Number | 1750490876
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Entity Type | Organization
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Legal Business Name | GUARDIAN HART MEDICAL CARE
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 1074 SOUTHERN AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28306
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Country | US
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Telephone | 910-221-1590
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Fax | 910-221-1594
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Provider Business Mailing Address
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Address Line | 1074 SOUTHERN AVENUE
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City | FAYETTEVILLE
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State | NC
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Zip | 28306
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Country | US
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Telephone | 910-221-1590
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Fax | 910-221-1594
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Authorized Official
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Title or Position | INSURANCE BILLER
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Name | MRS. JONNA LYNN SQUIRES
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Credential |
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Telephone | 910-221-1590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 128677
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License Number State | NC
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