Individual
SUSAN HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1610 BROADRICK DR, DALTON, GA 30720-3012
(706) 279-1994
(706) 279-9229
Mailing address
1610 BROADRICK DR, DALTON, GA 30720-3012
(706) 279-1994
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
065257
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
813405133D
—
GA
Enumeration date
07/10/2006
Last updated
03/17/2017
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