MEDICARE: GINGER ROSE HARDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTH10497	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT016760	OTHER	GA	GA LICENSE

General Provider Information

NPI Number	:	1154068294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINGER ROSE HARDY

Provider Business Mailing Address
First Line	:	PO BOX 8068
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31908-8068
Country	:	US
Telephone Number	:	706-320-5483
Fax Number	:	63-205-4837

Provider Business Practice Location Address
First Line	:	1157B WEST AVE SW
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30012-5280
Country	:	US
Telephone Number	:	770-922-2120
Fax Number	:	770-922-1096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	09/13/2023

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Directions to “ GINGER ROSE HARDY ” Practice Location

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