Provider Demographics
NPI:1376597740
Name:HARDY, WILLIAM LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAURENCE
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 N DUNCAN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3100
Mailing Address - Country:US
Mailing Address - Phone:931-879-6293
Mailing Address - Fax:423-569-5238
Practice Address - Street 1:114 N DUNCAN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3100
Practice Address - Country:US
Practice Address - Phone:931-879-6293
Practice Address - Fax:423-569-5238
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN028707207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64925100Medicaid
KY64925100Medicaid
A87887Medicare UPIN