Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 009513 | GA |
NPI | 1265526925 |
---|---|
Provider Name | John H Hartley JR. |
First Address | Atlanta, GA 30327-3054 |
Second Address | Atlanta, GA 30327-3054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009513 | LICENSE (01) | GA |