Provider Demographics
NPI:1417997586
Name:HARDBECK, CHRISTOPHER D (PAA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:HARDBECK
Suffix:
Gender:M
Credentials:PAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4894 DOVECOTE TRL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7301
Mailing Address - Country:US
Mailing Address - Phone:678-546-1171
Mailing Address - Fax:678-546-1171
Practice Address - Street 1:4894 DOVECOTE TRL
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7301
Practice Address - Country:US
Practice Address - Phone:678-546-1171
Practice Address - Fax:678-546-1171
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002853367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS26359Medicare UPIN
GA97BBGBSMedicare PIN