Healthcare Provider Details

I. General information

NPI: 1184591018
Provider Name (Legal Business Name): MARY AILYN HURLEY MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

2055 BARRETT LAKES BLVD NW APT 532
KENNESAW GA
30144-8001
US

V. Phone/Fax

Practice location:
  • Phone: 470-793-7472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number842
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: