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General NPI Number Information
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NPI Number | 1881640035
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Entity Type | Organization
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Legal Business Name | HARDEE FAMILY MEDICINE PA
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 444 WILLIAMSON RD SUITE E
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City | MOORESVILLE
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State | NC
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Zip | 28117
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Country | US
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Telephone | 704-658-9779
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Fax | 704-658-9773
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Provider Business Mailing Address
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Address Line | 444 WILLIAMSON RD STE E
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City | MOORESVILLE
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State | NC
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Zip | 28117-9248
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Country | US
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Telephone | 704-658-9779
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Fax | 704-658-9773
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MICHAEL WAYNE HARDEE
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Credential | MD
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Telephone | 704-658-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200000816
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License Number State | NC
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