Healthcare Provider Details

I. General information

NPI: 1396083606
Provider Name (Legal Business Name): DEBORAH LUANN HURD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CHURCH ST NE SUITE 330
MARIETTA GA
30060-7282
US

IV. Provider business mailing address

790 CHURCH ST NE SUITE 330
MARIETTA GA
30060-7282
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-2025
  • Fax: 770-425-1789
Mailing address:
  • Phone: 770-424-2025
  • Fax: 770-425-1789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN139521
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: