Provider Demographics
NPI:1386636140
Name:HARDIN, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:HARDIN
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 1:205 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-4011
Mailing Address - Country:US
Mailing Address - Phone:662-453-6732
Mailing Address - Fax:662-453-6734
Practice Address - Street 1:205 8TH ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-4011
Practice Address - Country:US
Practice Address - Phone:662-453-6732
Practice Address - Fax:662-453-6734
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07014208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04371729Medicaid
MS00017506Medicaid
MSB29911Medicare UPIN
MS00017506Medicaid
MS04371729Medicaid
MSC00182Medicare ID - Type UnspecifiedPRIMARY MEDICARE GROUP#