Healthcare Provider Details

I. General information

NPI: 1891225850
Provider Name (Legal Business Name): ZACHARY SAMUEL HURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N BELAIR RD STE 3C
EVANS GA
30809-3191
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY SE STE 1700
ATLANTA GA
30339-3087
US

V. Phone/Fax

Practice location:
  • Phone: 706-620-3635
  • Fax: 706-620-3623
Mailing address:
  • Phone: 770-953-6929
  • Fax: 770-953-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number95785
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: