Provider Demographics
NPI:1124027685
Name:HARTLEY, MARK ALAN (MPAS PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALAN
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:MPAS PA-C
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Mailing Address - Street 1:1063 LEE ROAD 338
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-1219
Mailing Address - Country:US
Mailing Address - Phone:706-761-8293
Mailing Address - Fax:
Practice Address - Street 1:7950 MARTIN LOOP
Practice Address - Street 2:MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5647
Practice Address - Country:US
Practice Address - Phone:706-545-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1033608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical