Provider Demographics
NPI:1912499641
Name:HARDIE, TIMOTHY J
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:HARDIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 E LAMAR ST STE 1
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3781
Mailing Address - Country:US
Mailing Address - Phone:229-928-4755
Mailing Address - Fax:229-928-4750
Practice Address - Street 1:1102 E LAMAR ST STE 1
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3781
Practice Address - Country:US
Practice Address - Phone:229-928-4755
Practice Address - Fax:229-928-4750
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily