Provider Demographics
NPI:1265790182
Name:HARE, JUSTIN (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HARE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLOWBROOK WAY SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1404
Mailing Address - Country:US
Mailing Address - Phone:706-529-9041
Mailing Address - Fax:706-529-9631
Practice Address - Street 1:1525 CHATTANOOGA RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8379
Practice Address - Country:US
Practice Address - Phone:706-529-7124
Practice Address - Fax:706-529-7126
Is Sole Proprietor?:No
Enumeration Date:2012-04-28
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2935207P00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine