Healthcare Provider Details

I. General information

NPI: 1780179390
Provider Name (Legal Business Name): LAURIE HUTCHINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E BROAD ST
MOUNT VERNON GA
30445-3018
US

IV. Provider business mailing address

215 N COLEMAN ST
SWAINSBORO GA
30401-3530
US

V. Phone/Fax

Practice location:
  • Phone: 912-583-2277
  • Fax: 912-583-2286
Mailing address:
  • Phone: 478-237-2638
  • Fax: 478-237-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN211666
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: