Provider Demographics
NPI:1659563500
Name:HARTLEY, ED N (ATP, CEAC)
Entity Type:Individual
Prefix:MR
First Name:ED
Middle Name:N
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:ATP, CEAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 ARREL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3715
Mailing Address - Country:US
Mailing Address - Phone:706-322-0003
Mailing Address - Fax:706-563-1344
Practice Address - Street 1:3723 ARREL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3715
Practice Address - Country:US
Practice Address - Phone:706-322-0003
Practice Address - Fax:706-563-1344
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALVU404983251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion