Healthcare Provider Details

I. General information

NPI: 1083843221
Provider Name (Legal Business Name): JEFFERSON T HUNT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD
COLUMBUS GA
31905-2102
US

IV. Provider business mailing address

6600 VAN AALST BLVD
COLUMBUS GA
31905-2102
US

V. Phone/Fax

Practice location:
  • Phone: 762-408-3305
  • Fax:
Mailing address:
  • Phone: 762-408-3305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65262
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number65262
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number65262
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: