Provider Demographics
NPI:1295715795
Name:HARDIN, GEOFFREY LANCE (PA-C)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:LANCE
Last Name:HARDIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:LANCE
Other - Middle Name:
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2610 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0637
Mailing Address - Country:US
Mailing Address - Phone:704-865-5210
Mailing Address - Fax:704-865-6282
Practice Address - Street 1:2610 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0637
Practice Address - Country:US
Practice Address - Phone:704-865-5210
Practice Address - Fax:704-865-6282
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103904363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant