Provider Demographics
NPI:1992039283
Name:HARDIN, VIRGIL M
Entity Type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:M
Last Name:HARDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 OWENS RD
Mailing Address - Street 2:APT. 518
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3066
Mailing Address - Country:US
Mailing Address - Phone:706-650-1002
Mailing Address - Fax:
Practice Address - Street 1:4275 OWENS RD
Practice Address - Street 2:APT. 518
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3066
Practice Address - Country:US
Practice Address - Phone:706-650-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009156208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice