Provider Demographics
NPI:1154971398
Name:HARDIMAN, GLORIA J
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:HARDIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 RIVER FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3145
Mailing Address - Country:US
Mailing Address - Phone:770-969-5081
Mailing Address - Fax:
Practice Address - Street 1:245 RIVER FOREST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3145
Practice Address - Country:US
Practice Address - Phone:770-969-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherDEPARTMENT OF VA