Provider Demographics
NPI:1144400839
Name:HARDY, WILLIAM WADE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WADE
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:330 HOSPITAL DRIVE
Mailing Address - Street 2:BUILDING C, SUITE 302
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217
Mailing Address - Country:US
Mailing Address - Phone:478-257-6868
Mailing Address - Fax:478-238-6688
Practice Address - Street 1:330 HOSPITAL DRIVE
Practice Address - Street 2:BUILDING C, SUITE 302
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217
Practice Address - Country:US
Practice Address - Phone:478-257-6868
Practice Address - Fax:478-238-6688
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA001300207R00000X
GA60847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARES0000Medicare UPIN