Healthcare Provider Details

I. General information

NPI: 1356411474
Provider Name (Legal Business Name): KRISTI SHOOK HUNTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 MIMS RD
SYLVANIA GA
30467-1994
US

IV. Provider business mailing address

217 ARCHDALE DR
AIKEN SC
29803-8551
US

V. Phone/Fax

Practice location:
  • Phone: 912-564-7426
  • Fax:
Mailing address:
  • Phone: 803-642-4233
  • Fax: 803-643-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number040697
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: