Provider Demographics
NPI:1649718784
Name:HARDEMAN, NICOLE LANE (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LANE
Last Name:HARDEMAN
Suffix:
Gender:
Credentials:DO
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:LANE
Other - Last Name:HOAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:800 GI MADDOX PKWY
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-4008
Mailing Address - Country:US
Mailing Address - Phone:706-686-8015
Mailing Address - Fax:706-686-8221
Practice Address - Street 1:800 GI MADDOX PKWY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-4008
Practice Address - Country:US
Practice Address - Phone:706-686-8015
Practice Address - Fax:706-686-8063
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93066207Q00000X
OH34.014510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine