Provider Demographics
NPI:1245875012
Name:HARDY, OMEGA DALE ELLISON (NNP-BC)
Entity type:Individual
Prefix:
First Name:OMEGA
Middle Name:DALE ELLISON
Last Name:HARDY
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:OMEGA
Other - Middle Name:DALE
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:801 MONTCLAIR RD APT 4220
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HEALTHCARE OF ATLANTA 1405 CLIFTON ROAD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1700
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173540163WN0002X
GARN307749363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care