Provider Demographics
NPI:1689616567
Name:HARDISON, JAMES KEVIN (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:HARDISON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1040
Mailing Address - Country:US
Mailing Address - Phone:704-632-8032
Mailing Address - Fax:704-632-8034
Practice Address - Street 1:335 BILLINGSLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1040
Practice Address - Country:US
Practice Address - Phone:704-632-8032
Practice Address - Fax:704-632-8034
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC475213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908097Medicaid
NC08097OtherBCBSNC
NC806670OtherPARTNERS MEDICARE
NC7908097Medicaid
NC806670OtherPARTNERS MEDICARE