Provider Demographics
NPI:1275827396
Name:HARDEN, TOREY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:TOREY
Middle Name:SCOTT
Last Name:HARDEN
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 1:301 MEDICAL DR
Mailing Address - Street 2:STE 504
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4144
Mailing Address - Country:US
Mailing Address - Phone:706-812-2655
Mailing Address - Fax:706-812-2428
Practice Address - Street 1:301 MEDICAL DR
Practice Address - Street 2:STE 504
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4144
Practice Address - Country:US
Practice Address - Phone:706-812-2655
Practice Address - Fax:706-812-2428
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA71831208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program