Healthcare Provider Details

I. General information

NPI: 1902515133
Provider Name (Legal Business Name): ANGELIA CLAYMON HURLEY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 CENTURY LN
JOHNSON CITY TN
37604-4469
US

IV. Provider business mailing address

310 SUGARTREE RD
PINEY FLATS TN
37686-4303
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-6941
  • Fax:
Mailing address:
  • Phone: 423-943-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number5617
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: