Provider Demographics
NPI:1255043071
Name:HARDEMAN, JOHNNY KYLE II (RN)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:KYLE
Last Name:HARDEMAN
Suffix:II
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 RUSTICWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2849
Mailing Address - Country:US
Mailing Address - Phone:912-541-4983
Mailing Address - Fax:
Practice Address - Street 1:2819 RUSTICWOOD DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2849
Practice Address - Country:US
Practice Address - Phone:912-541-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA249198163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health