Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 071791 | GA |
N | 207RA0401X | Internist - Addiction Medicine | 2663 | TN |
NPI | 1811121924 |
---|---|
Provider Name | Dr. Joshua Lidelle Hare |
First Address | Dalton, GA 30720-8662 |
Second Address | Dalton, GA 30720-8662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 14/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003147609A | (05) | GA |
02045387 | AMERIGROUP (01) | GA |
988220 | WELLCARE (01) | GA |
P01363024 | RR MEDICARE (01) | GA |