Healthcare Provider Details

I. General information

NPI: 1942138730
Provider Name (Legal Business Name): JONATHAN MITCHEL HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EASTOWNE DR
CHAPEL HILL NC
27514-2286
US

IV. Provider business mailing address

1900 TOLL BRIDGE CT
ALEXANDRIA VA
22308-2447
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-4462
  • Fax:
Mailing address:
  • Phone: 703-409-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRTL26-0312
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: