Provider Demographics
NPI:1528873593
Name:HARDIN, JACESON S
Entity type:Individual
Prefix:
First Name:JACESON
Middle Name:S
Last Name:HARDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 THRUSH CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4415
Mailing Address - Country:US
Mailing Address - Phone:850-624-2582
Mailing Address - Fax:
Practice Address - Street 1:935 RONALD REAGAN DR UNIT 103
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-7622
Practice Address - Country:US
Practice Address - Phone:706-922-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014516225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist