Healthcare Provider Details

I. General information

NPI: 1306592498
Provider Name (Legal Business Name): BRIDGET HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2022
Last Update Date: 02/27/2022
Certification Date: 02/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4078 TOWNSEND LN
ATLANTA GA
30346-1664
US

IV. Provider business mailing address

4078 TOWNSEND LN
ATLANTA GA
30346-1664
US

V. Phone/Fax

Practice location:
  • Phone: 404-692-8248
  • Fax:
Mailing address:
  • Phone: 404-692-8248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN290264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: