Provider Demographics
NPI:1225039258
Name:HARDISON, BARRY G (MD, FASAM)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:G
Last Name:HARDISON
Suffix:
Gender:M
Credentials:MD, FASAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PHILLIP STONE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1929
Mailing Address - Country:US
Mailing Address - Phone:270-754-3494
Mailing Address - Fax:270-377-1683
Practice Address - Street 1:222 PHILLIP STONE WAY
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1929
Practice Address - Country:US
Practice Address - Phone:270-754-3494
Practice Address - Fax:270-754-3499
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23875207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64238751Medicaid
KY0652404Medicare PIN
KY64238751Medicaid