Provider Demographics
NPI:1235323551
Name:WILLIAM R HARDCASTLE MD PC
Entity Type:Organization
Organization Name:WILLIAM R HARDCASTLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARDCASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-296-0148
Mailing Address - Street 1:3525 PIEDMONT RD NE
Mailing Address - Street 2:BLDG 7-601
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1578
Mailing Address - Country:US
Mailing Address - Phone:404-842-5400
Mailing Address - Fax:404-848-1213
Practice Address - Street 1:487 WINN WAY STE 103
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1700
Practice Address - Country:US
Practice Address - Phone:404-296-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6626Medicare PIN
GA023403721Medicare PIN
GAD29686Medicare UPIN