Healthcare Provider Details

I. General information

NPI: 1164418596
Provider Name (Legal Business Name): JOSEPHINE HIGGINS HURLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 TURNER MCCALL BLVD SW
ROME GA
30165-5630
US

IV. Provider business mailing address

PO BOX 102186
ATLANTA GA
30368-2186
US

V. Phone/Fax

Practice location:
  • Phone: 706-802-2000
  • Fax: 706-233-9846
Mailing address:
  • Phone: 706-802-2000
  • Fax: 706-737-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN091749
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: