Provider Demographics
NPI:1740161017
Name:HARTLEY, JENNIFER DIANE (MT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIANE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 FLOWING WELL RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-3153
Mailing Address - Country:US
Mailing Address - Phone:706-831-2889
Mailing Address - Fax:
Practice Address - Street 1:1534 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3437
Practice Address - Country:US
Practice Address - Phone:229-435-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist