Healthcare Provider Details

I. General information

NPI: 1033395553
Provider Name (Legal Business Name): CYNTHIA ANN HURLEY M.D. MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4062 PEACHTREE RD NE STE C
ATLANTA GA
30319-3021
US

IV. Provider business mailing address

4062 PEACHTREE RD NE STE C
ATLANTA GA
30319-3021
US

V. Phone/Fax

Practice location:
  • Phone: 404-231-4231
  • Fax: 404-816-1030
Mailing address:
  • Phone: 404-231-4231
  • Fax: 404-816-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP62221
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: