Provider Demographics
NPI:1235141888
Name:HARTWIG, GEOFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:B
Last Name:HARTWIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5463
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:415 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7246
Practice Address - Country:US
Practice Address - Phone:601-268-5620
Practice Address - Fax:601-268-5851
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS090592084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019370Medicaid
409113663OtherRAILROAD MEDICARE
MS1558946OtherAMERICAN ADMIN GROUP
LA1589586Medicaid
MS00019370Medicaid
MS1558946OtherAMERICAN ADMIN GROUP