Healthcare Provider Details

I. General information

NPI: 1689400509
Provider Name (Legal Business Name): JADEN SHEMAR HURT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 ELMA G MILES PKWY STE B
HINESVILLE GA
31313-4004
US

IV. Provider business mailing address

481 ELMA G MILES PKWY STE B
HINESVILLE GA
31313-4004
US

V. Phone/Fax

Practice location:
  • Phone: 912-532-9774
  • Fax:
Mailing address:
  • Phone: 912-532-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-282560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: