Individual
MR. KENNETH RUSSELL HARDIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 LANTANA RD STE 202A, CROSSVILLE, TN 38555-1915
(931) 484-5141
(865) 374-2074
Mailing address
100 LANTANA RD STE 202A, CROSSVILLE, TN 38555-1915
(931) 484-5141
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
039120
GA
207RC0000X
Cardiovascular Disease Physician
65348
TN
207RI0011X
Interventional Cardiology Physician
Primary
65348
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000852596A
—
GA
05
—
00627327G
—
GA
05
—
Q074573
—
TN
Enumeration date
10/20/2005
Last updated
11/04/2024
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