Provider Demographics
NPI:1316020324
Name:HARGROVE, MARTHA ELLEN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ELLEN
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 BARRETT PLANTATION LN
Mailing Address - Street 2:PO BOX 1658
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-2713
Mailing Address - Country:US
Mailing Address - Phone:706-437-9678
Mailing Address - Fax:706-437-9678
Practice Address - Street 1:114 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-5446
Practice Address - Country:US
Practice Address - Phone:706-554-3456
Practice Address - Fax:706-554-2944
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089372163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management