Healthcare Provider Details

I. General information

NPI: 1821219312
Provider Name (Legal Business Name): JANET HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4192 SALEM RD SUITE 400
COVINGTON GA
30016-4532
US

IV. Provider business mailing address

4192 SALEM RD SUITE 400
COVINGTON GA
30016-4532
US

V. Phone/Fax

Practice location:
  • Phone: 770-788-2026
  • Fax:
Mailing address:
  • Phone: 770-788-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN057139
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: