Provider Demographics
NPI:1154068294
Name:HARDY, GINGER ROSE
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:ROSE
Last Name:HARDY
Suffix:
Gender:F
Credentials:
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 8068
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8068
Mailing Address - Country:US
Mailing Address - Phone:706-320-5483
Mailing Address - Fax:063-205-4837
Practice Address - Street 1:1157B WEST AVE SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5280
Practice Address - Country:US
Practice Address - Phone:770-922-2120
Practice Address - Fax:770-922-1096
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT016760OtherGA LICENSE