Provider Demographics
NPI:1841337524
Name:HARTPENCE, ANDREW JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHN
Last Name:HARTPENCE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1609
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0038
Mailing Address - Country:US
Mailing Address - Phone:770-227-0333
Mailing Address - Fax:770-228-4788
Practice Address - Street 1:1005 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2607
Practice Address - Country:US
Practice Address - Phone:770-227-0333
Practice Address - Fax:770-228-4788
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55002864AMedicaid
GA35ZCJBTMedicare ID - Type Unspecified
GAU35979Medicare UPIN