Healthcare Provider Details

I. General information

NPI: 1659321743
Provider Name (Legal Business Name): SUSAN C HURT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW SUITE 640
ATLANTA GA
30327-1610
US

IV. Provider business mailing address

3200 DOWNWOOD CIR NW SUITE 640
ATLANTA GA
30327-1610
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-0051
  • Fax: 404-351-0632
Mailing address:
  • Phone: 404-351-0051
  • Fax: 404-351-0632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number027832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: