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General NPI Number Information
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NPI Number | 1144395765
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Entity Type | Individual
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Provider Name | GINA LANELLE HURT D.M.D
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Gender | Female
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | SUITE125-E 1000JOHNSON FERRY ROAD SUITE125-E
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City | MARRIETA
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State | GA
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Zip | 30068
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Country | US
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Telephone | 770-579-0802
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Fax | 770-579-0340
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Provider Business Mailing Address
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Address Line | SUITE125-E 1000JOHNSON FERRY ROAD
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City | MARRIETA
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State | GA
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Zip | 30068
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Country | US
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Telephone | 770-579-0802
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Fax | 770-579-0340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 011336
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License Number State | GA
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