Provider Demographics
NPI:1790773380
Name:HARDY, ALICE MANSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MANSELL
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W. SPRING STREET
Mailing Address - Street 2:SUITE300
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150
Mailing Address - Country:US
Mailing Address - Phone:256-208-0060
Mailing Address - Fax:256-208-0755
Practice Address - Street 1:209 W SPRING ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2973
Practice Address - Country:US
Practice Address - Phone:256-208-0060
Practice Address - Fax:256-208-0755
Is Sole Proprietor?:No
Enumeration Date:2005-10-09
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00025409208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL171934Medicaid
AL511-63604OtherBCBS CHELSEA
AL171777Medicaid
AL511-63551OtherBCBS
I01025Medicare UPIN