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General NPI Number Information
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NPI Number | 1831476506
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Entity Type | Individual
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Provider Name | NICHOLAS Q DE LA MOTTE HURST PA
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Gender | Male
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 1498 JESSE JEWELL PKWY SE STE A
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City | GAINESVILLE
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State | GA
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Zip | 30501-3874
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Country | US
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Telephone | 678-257-2547
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Fax | 404-795-5832
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Provider Business Mailing Address
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Address Line | 3237 SATELLITE BLVD STE 425
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City | DULUTH
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State | GA
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Zip | 30096-9009
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Country | US
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Telephone | 678-257-2547
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Fax | 404-795-5832
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 53067
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 006327
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License Number State | GA
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