Healthcare Provider Details

I. General information

NPI: 1114517273
Provider Name (Legal Business Name): DAVID LOWELL HURLEY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROOM 330 BLDG 7 MAPLE AVE GATTON COLLEGE OF PHARMACY
JOHNSON CITY TN
37614
US

IV. Provider business mailing address

PO BOX 70594
JOHNSON CITY TN
37614-1708
US

V. Phone/Fax

Practice location:
  • Phone: 18-285-5009
  • Fax:
Mailing address:
  • Phone: 828-550-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: