Healthcare Provider Details

I. General information

NPI: 1063638732
Provider Name (Legal Business Name): ROBERT TRAVIS HURD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LAUREL CREEK RD SE STE 11A
CALHOUN GA
30701-7011
US

IV. Provider business mailing address

109 DERBY LN
CALHOUN GA
30701-2012
US

V. Phone/Fax

Practice location:
  • Phone: 678-986-5060
  • Fax:
Mailing address:
  • Phone: 678-986-5060
  • Fax: 706-275-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3770
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003770
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: