Provider Demographics
NPI:1508377078
Name:HARTLEY, JAMISON LOUIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMISON
Middle Name:LOUIS
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2041 MESA VALLEY WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6828
Mailing Address - Country:US
Mailing Address - Phone:770-944-1100
Mailing Address - Fax:
Practice Address - Street 1:2041 MESA VALLEY WAY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6828
Practice Address - Country:US
Practice Address - Phone:770-944-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant