Provider Demographics
NPI:1487268710
Name:HARDIN, CALLEN RUTH (ATC)
Entity type:Individual
Prefix:
First Name:CALLEN
Middle Name:RUTH
Last Name:HARDIN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 BEAUJOLAIS SQ
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4354
Mailing Address - Country:US
Mailing Address - Phone:423-737-3374
Mailing Address - Fax:
Practice Address - Street 1:7469 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-5394
Practice Address - Country:US
Practice Address - Phone:423-636-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2558207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine