Provider Demographics
NPI:1619941473
Name:HARDER, NATASHA M (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:M
Last Name:HARDER
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 1:209B DEXTER L WOODS MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2416
Mailing Address - Country:US
Mailing Address - Phone:931-722-7724
Mailing Address - Fax:931-722-7633
Practice Address - Street 1:209B DEXTER L WOODS MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2416
Practice Address - Country:US
Practice Address - Phone:931-722-7724
Practice Address - Fax:931-722-7633
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056570207Q00000X
ALMD.22798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA856772476AMedicaid
GA856772476AMedicaid
GA08BDHZLMedicare ID - Type Unspecified