Provider Demographics
NPI:1104149319
Name:HARTLEY, CHRISTY L (CNM/ARNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:CNM/ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HARRIS INDUSTRIAL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8852
Mailing Address - Country:US
Mailing Address - Phone:912-537-1014
Mailing Address - Fax:912-538-0979
Practice Address - Street 1:1707 MEADOWS LN STE A
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-7201
Practice Address - Country:US
Practice Address - Phone:912-537-1014
Practice Address - Fax:912-538-0979
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN150227363L00000X, 363LF0000X, 363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN150227OtherLICENSE
FLDW346YMedicare PIN
FLK6180Medicare UPIN
FLDW346YMedicare PIN
FL270764100Medicaid