Organization
GERONTOLOGY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS HARTWIG IV PHD (PRESIDENT)
(616) 456-6135
Entity
Organization
Contact information
Practice address
4650 W US HIGHWAY 223 STE A, ADRIAN, MI 49221-8494
(517) 226-2588
(517) 226-0224
Mailing address
500 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
(616) 456-6135
(616) 771-9771
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
03/01/2007
Last updated
05/02/2008
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