Provider Demographics
NPI:1740475052
Name:HARDCHOICES LLC
Entity type:Organization
Organization Name:HARDCHOICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:FENLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:386-960-7830
Mailing Address - Street 1:1895 PHOENIX BLVD
Mailing Address - Street 2:SUITE 338
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5592
Mailing Address - Country:US
Mailing Address - Phone:678-604-0891
Mailing Address - Fax:678-604-0891
Practice Address - Street 1:2583 S VOLUSIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9129
Practice Address - Country:US
Practice Address - Phone:386-960-7830
Practice Address - Fax:386-960-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME-122760207R00000X
207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDLZQOtherMEDICARE UNSPEC.
GA05500293AMedicaid