Healthcare Provider Details

I. General information

NPI: 1417710732
Provider Name (Legal Business Name): ABIGAIL HURLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 FAYETTEVILLE RD SE
ATLANTA GA
30316-2921
US

IV. Provider business mailing address

3401 VANDIVER DR
MARIETTA GA
30066-4649
US

V. Phone/Fax

Practice location:
  • Phone: 404-357-5922
  • Fax:
Mailing address:
  • Phone: 404-357-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008857
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: