Provider Demographics
NPI:1518432947
Name:HARDY, HEATHER (IBCLC, RLC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HERITAGE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-6307
Mailing Address - Country:US
Mailing Address - Phone:706-980-4028
Mailing Address - Fax:
Practice Address - Street 1:109 HERITAGE OAKS DR
Practice Address - Street 2:
Practice Address - City:BALL GROUND
Practice Address - State:GA
Practice Address - Zip Code:30107-6307
Practice Address - Country:US
Practice Address - Phone:706-980-4028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALC000137174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-35601OtherIBLCE