Healthcare Provider Details

I. General information

NPI: 1770753089
Provider Name (Legal Business Name): ANDREW J HURAYT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LEE ST
BRUNSWICK GA
31520-7132
US

IV. Provider business mailing address

PO BOX 918
BRUNSWICK GA
31521-0918
US

V. Phone/Fax

Practice location:
  • Phone: 912-261-0510
  • Fax: 912-261-0593
Mailing address:
  • Phone: 912-261-0510
  • Fax: 912-261-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number015196
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number015196
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: