Healthcare Provider Details

I. General information

NPI: 1376838706
Provider Name (Legal Business Name): SABINE HURST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 09/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HIGHWAY 155 N
MCDONOUGH GA
30252-4806
US

IV. Provider business mailing address

2200 HIGHWAY 155 N
MCDONOUGH GA
30252-4806
US

V. Phone/Fax

Practice location:
  • Phone: 678-490-0341
  • Fax: 678-490-0349
Mailing address:
  • Phone: 678-490-0341
  • Fax: 678-490-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN182617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: