Provider Demographics
NPI:1861463184
Name:HARTLEY, JOHN THOMAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:HARTLEY
Suffix:III
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 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-539-4080
Mailing Address - Fax:256-539-4099
Practice Address - Street 1:930 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4312
Practice Address - Country:US
Practice Address - Phone:256-539-4080
Practice Address - Fax:256-539-4099
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10550207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL192874Medicaid
AL510-49247OtherBCBS
AL515-99684OtherBCBS
AL510-49248OtherBCBS
AL515-99678OtherBCBS
4003557OtherAETNA
ALP00770780OtherRAILROAD MEDICARE
060037260OtherRAILROAD MEDICARE
25-10123OtherUNITED HEALTHCARE
AL510-49249OtherBCBS
TN0084896OtherBCBS
AL515-99683OtherBCBS
AL51033802OtherBCBS
AL112499Medicaid
AL515-99684OtherBCBS
AL112493Medicaid
AL112494Medicaid
AL515-99683OtherBCBS
ALP00770780OtherRAILROAD MEDICARE
AL515-99683OtherBCBS
TN0084896OtherBCBS
AL112499Medicaid
AL000033802Medicare PIN