Healthcare Provider Details

I. General information

NPI: 1477249944
Provider Name (Legal Business Name): EMILY MARIE HURST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS EMILY MARIE HURST-HARDISTY

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 09/27/2024
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GI MADDOX PARKWAY
CHATSWORTH GA
30705
US

IV. Provider business mailing address

1200 MEMORIAL DRIVE
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 706-686-8015
  • Fax: 706-686-8221
Mailing address:
  • Phone: 706-226-8996
  • Fax: 706-272-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number14813
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: