Individual
FREDERICK C HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
203 E WATAUGA AVE, JOHNSON CITY, TN 37601-4629
(423) 926-2129
(423) 926-8576
Mailing address
203 E WATAUGA AVE, JOHNSON CITY, TN 37601-4629
(423) 926-2129
(423) 926-8576
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
11190
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3173953
—
TN
Enumeration date
06/15/2005
Last updated
07/08/2007
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