Provider Demographics
NPI:1154306587
Name:HARTMANN, ERICA LYN (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYN
Last Name:HARTMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:BLDG 77 5TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-605-4602
Mailing Address - Fax:404-367-4447
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:BLDG 77 5TH FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-4602
Practice Address - Fax:404-367-4447
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300045207RN0300X
GA064558207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C3082OtherMEDCOST
802249OtherPARTNERS
NC89133V3Medicaid
SCQ45003Medicaid
133V3OtherBCBS
WV2006272000Medicaid
VA5884420Medicaid
7824264OtherAETNA
C3082OtherMEDCOST
NC89133V3Medicaid
WV2006272000Medicaid