Healthcare Provider Details

I. General information

NPI: 1417529405
Provider Name (Legal Business Name): ALEXANDRIA DAWES HURLEY BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRIA DAWES HURLEY BSN, RN

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BELLE MEADE DR SW
ROME GA
30165-8487
US

IV. Provider business mailing address

9 BELLE MEADE DR SW
ROME GA
30165-8487
US

V. Phone/Fax

Practice location:
  • Phone: 706-676-2325
  • Fax:
Mailing address:
  • Phone: 706-676-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN269395
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6823
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: