Healthcare Provider Details

I. General information

NPI: 1205862430
Provider Name (Legal Business Name): ANNA ELIZABETH HURLEBAUS RN, MS., CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/06/2025
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 LENOX ROAD NE SUITE 1000
ATLANTA GA
30326
US

IV. Provider business mailing address

2688 GOODFELLOWS RD
TUCKER GA
30084-2702
US

V. Phone/Fax

Practice location:
  • Phone: 404-788-2320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN081291
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN081291
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: