MEDICARE: COURTNEY J HOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1619696275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY J HOOD

Provider Business Mailing Address
First Line	:	6131 SPARKLING COVE LN
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30518-7226
Country	:	US
Telephone Number	:	205-531-1642
Fax Number	:

Provider Business Practice Location Address
First Line	:	6131 SPARKLING COVE LN
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30518-7226
Country	:	US
Telephone Number	:	205-531-1642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	08/25/2022

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