Provider Demographics
NPI:1629053277
Name:HARDY, LE ANTHONY ANDRE (MD)
Entity Type:Individual
Prefix:DR
First Name:LE ANTHONY
Middle Name:ANDRE
Last Name:HARDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8824
Mailing Address - Fax:
Practice Address - Street 1:1331 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2357
Practice Address - Country:US
Practice Address - Phone:770-629-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39951207R00000X
GA052184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4327022OtherBCBS - TENNESSEE
TN1511186Medicaid
GA103I114315Medicare PIN
TN1511186Medicaid