Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301103891 | MI |
N | 208600000X | Surgeon | 4301103891 | MI |
N | 208200000X | Surgeon | 83901 | GA |
N | 208600000X | Surgeon | 83901 | GA |
Y | 2086X0206X | Surgical Oncologist | 83901 | GA |
N | 2086X0206X | Surgical Oncologist | LP04152 | RI |
NPI | 1043585185 |
---|---|
Provider Name | Dr. John Crawford Hardaway |
First Address | Augusta, GA 30909-6580 |
Second Address | Providence, RI 02908-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2012 |
Last Update Date | 04/01/2022 |