Provider Demographics
NPI:1205476348
Name:HARDY, DEMETRIUS E
Entity type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:E
Last Name:HARDY
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 1:3100 GREENSBORO AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7008
Mailing Address - Country:US
Mailing Address - Phone:205-523-7641
Mailing Address - Fax:205-860-5164
Practice Address - Street 1:3100 GREENSBORO AVE STE 2
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7008
Practice Address - Country:US
Practice Address - Phone:205-523-7641
Practice Address - Fax:205-860-5164
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician