Provider Demographics
NPI:1225684988
Name:HARTSOG, CAROL A (CNM)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:HARTSOG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 FLINCHUM RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:NC
Mailing Address - Zip Code:27016-7400
Mailing Address - Country:US
Mailing Address - Phone:336-978-2657
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHLINE AVE STE 130
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7600
Practice Address - Country:US
Practice Address - Phone:336-286-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife