Provider Demographics
NPI:1205903945
Name:HARDY, ERIC (PA-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:HARDY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 VIRGINIA RD STE 8100
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1446
Mailing Address - Country:US
Mailing Address - Phone:205-213-9122
Mailing Address - Fax:
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-933-7838
Practice Address - Fax:205-933-0951
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0040363A00000X
ALPA403363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ27783Medicare UPIN
AL051555190HARMedicare ID - Type Unspecified