Healthcare Provider Details

I. General information

NPI: 1184685927
Provider Name (Legal Business Name): TERESA T. HURST PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 DOLLEY MADISON RD STE 410
GREENSBORO NC
27410-5167
US

IV. Provider business mailing address

445 DOLLEY MADISON RD STE 410
GREENSBORO NC
27410-5167
US

V. Phone/Fax

Practice location:
  • Phone: 336-292-1510
  • Fax: 336-292-0679
Mailing address:
  • Phone: 336-292-1510
  • Fax: 336-292-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number104165
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: