Provider Demographics
NPI:1821158882
Name:HART, JAMES KEVIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:KEVIN
Last Name:HART
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DRIVE
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:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:76 COUNTY ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:WOODLAND
Practice Address - State:AL
Practice Address - Zip Code:36280
Practice Address - Country:US
Practice Address - Phone:256-449-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.858363A00000X
GA003428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL970028537OtherRAIL ROAD MEDICARE
GA100001778AMedicaid
GA100001778AMedicaid
GAP51060Medicare UPIN