Healthcare Provider Details

I. General information

NPI: 1194038380
Provider Name (Legal Business Name): MISTY HINDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2774 N COBB PKWY
KENNESAW GA
30152-3469
US

IV. Provider business mailing address

8 CADILLAC DR STE 250
BRENTWOOD TN
37027-5087
US

V. Phone/Fax

Practice location:
  • Phone: 615-425-4200
  • Fax:
Mailing address:
  • Phone: 615-425-4287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN191957
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: