Individual
JOHN HARDISTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., PA-C
Contact information
Practice address
1201 7TH ST SE, DECATUR, AL 35601-3337
(256) 341-3328
(256) 341-2605
Mailing address
177 ROSS DR, MOUNTAIN BRK, AL 35213-2547
(205) 705-9178
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TA.1771
AL
Other
Enumeration date
01/22/2014
Last updated
01/22/2014
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