Healthcare Provider Details

I. General information

NPI: 1346223948
Provider Name (Legal Business Name): JOSEPH R HURST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SUSANNAH ST
JOHNSON CITY TN
37601-1748
US

IV. Provider business mailing address

2410 SUSANNAH ST
JOHNSON CITY TN
37601-1748
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-9011
  • Fax: 423-282-3003
Mailing address:
  • Phone: 423-282-9011
  • Fax: 423-282-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number100006796A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3409
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: