| Doctor Name: | CAROLYN ADELE HARDIN |
| NPI Number: | 1922422120 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 0102204223 |
| Business Practice Address: | 59 Mdsp/sgmd 2200 Bergquist Dr., Ste 1 Jbsa Lackland, TX - 782369900 |
| Business Phone Number: | 2102923376 |
| Business Fax Number: | 2102923781 |
| Mailing Address: | 59 Mdsp/sgmd, 2200 Bergquist Dr., Ste 1 JBSA LACKLAND |
| State: | TX |
| Postal Code: | 782369900 |
| Phone Number: | 2102923376 |
| Fax Number: | 2102923781 |
| NPI Enumeration Date: | 02/07/2014 |
| NPI Last Update Date: | 07/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0102204223 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |