Basic Information
| Provider Information | |||||||||
| NPI: | 1790738318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARDISON | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 CONNER DR | ||||||||
| Address2: | STE 101 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199428571 | ||||||||
| FaxNumber: | 9199426355 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 CONNER DR | ||||||||
| Address2: | STE 101 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199428571 | ||||||||
| FaxNumber: | 9199426355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 09/22/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 200200541 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 891317Y | 05 | NC | MEDICAID | 1317Y | 01 | NC | BCBS | OTHER | 420139 | 01 | NC | WELLPATH | OTHER | 187280 | 01 | NC | MEDCOST | OTHER | 562142486 | 01 | NC | BEECHSTREET | OTHER | 701891 | 01 | NC | UHC | OTHER | 2001322B | 01 | NC | MEDICARE PDC | OTHER | 1242321 | 01 | NC | AETNA | OTHER | 7918115 | 01 | NC | CIGNA | OTHER |