Provider Demographics
NPI:1013311307
Name:HARTLE, STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:HARTLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2576 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:770-888-8777
Mailing Address - Fax:770-888-8779
Practice Address - Street 1:2576 PEACHTREE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-888-8777
Practice Address - Fax:770-888-8779
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2015-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA7350363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical