Provider Demographics
NPI:1497319263
Name:HARTIGAN, CLARE
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:
Last Name:HARTIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 CANOPY CHASE NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2216
Mailing Address - Country:US
Mailing Address - Phone:678-549-0267
Mailing Address - Fax:404-464-7475
Practice Address - Street 1:1641 CANOPY CHASE NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-2216
Practice Address - Country:US
Practice Address - Phone:678-549-0267
Practice Address - Fax:404-464-7475
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty