Healthcare Provider Details

I. General information

NPI: 1265436539
Provider Name (Legal Business Name): GARY W HUNT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 OLD HIGHWAY 5 STE 104
BLUE RIDGE GA
30513-6239
US

IV. Provider business mailing address

7100 COMMERCE WAY SUITE 180
BRENTWOOD TN
37027-2829
US

V. Phone/Fax

Practice location:
  • Phone: 706-258-4868
  • Fax: 706-258-1165
Mailing address:
  • Phone: 615-465-7000
  • Fax: 615-309-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23837
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33359
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: