=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669555934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KURT P HOFMANN MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 06/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 HARRIS INDUSTRIAL BLVD SUITE 3
-----------------------------------------------------
City | VIDALIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30474-8845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-909-8354
-----------------------------------------------------
Fax | 912-538-0770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 HARRIS INDUSTRIAL BLVD SUITE 3
-----------------------------------------------------
City | VIDALIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30474-8850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-909-8354
-----------------------------------------------------
Fax | 912-538-0770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. KURT P HOFMANN
-----------------------------------------------------
Credential | MD FACS
-----------------------------------------------------
Telephone | 866-909-8354
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 051197
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------