Basic Information
| Provider Information | |||||||||
| NPI: | 1629053277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDY | ||||||||
| FirstName: | LE ANTHONY | ||||||||
| MiddleName: | ANDRE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 AMBULANCE DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708388824 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1331 MOUNT ZION RD | ||||||||
| Address2: | |||||||||
| City: | MORROW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302602357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706293217 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 11/01/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 39951 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 052184 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4327022 | 01 | TN | BCBS - TENNESSEE | OTHER | 1511186 | 05 | TN | MEDICAID |