Individual
JANE FAULK HARDEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
655 FIRST STREET, MACON, GA 31201
(478) 301-5930
(478) 301-5932
Mailing address
PO BOX 4947, MACON, GA 31208-4947
(478) 301-4111
(478) 301-2272
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW000304
GA
106H00000X
Marriage & Family Therapist
MFT000169
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000748811A
—
GA
01
—
800007277
RAILROAD MEDICARE
GA
Enumeration date
10/06/2006
Last updated
10/29/2014
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