Individual
KELLY HARDESTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1615 RIDENOUR BLVD NW STE 204, KENNESAW, GA 30152-4464
(770) 580-8070
(770) 285-8751
Mailing address
PO BOX 724557, ATLANTA, GA 31139-1557
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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