Provider Demographics
NPI:1033514302
Name:HARTLEY HEALTH AND WELLNESS ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HARTLEY HEALTH AND WELLNESS ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1470-210-1983
Mailing Address - Street 1:207 CRESTMONT WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8875
Mailing Address - Country:US
Mailing Address - Phone:147-021-0198
Mailing Address - Fax:147-077-7226
Practice Address - Street 1:207 CRESTMONT WAY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8875
Practice Address - Country:US
Practice Address - Phone:147-021-0198
Practice Address - Fax:147-077-7226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11050778251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20270G2992Medicare Oscar/Certification