Provider Demographics
NPI:1437180957
Name:HANSARD, DEBORAH I (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:I
Last Name:HANSARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 OLE HICKORY TRAIL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117
Mailing Address - Country:US
Mailing Address - Phone:770-830-1164
Mailing Address - Fax:
Practice Address - Street 1:405 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110-2005
Practice Address - Country:US
Practice Address - Phone:770-537-2367
Practice Address - Fax:770-537-1203
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00609738AMedicaid
GA00609738AMedicaid
GAE01490Medicare UPIN