Provider Demographics
NPI:1003393562
Name:HULETT, SIDNEY GINA
Entity Type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:GINA
Last Name:HULETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13431 CLEVELAND STREET
Mailing Address - Street 2:
Mailing Address - City:NAHUNTA
Mailing Address - State:GA
Mailing Address - Zip Code:31553
Mailing Address - Country:US
Mailing Address - Phone:912-282-2803
Mailing Address - Fax:912-287-6689
Practice Address - Street 1:13431 CLEVELAND STREET
Practice Address - Street 2:
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553
Practice Address - Country:US
Practice Address - Phone:912-282-2803
Practice Address - Fax:912-287-6689
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator