Provider Demographics
NPI:1083342182
Name:HORNE, COREY BROOKS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:BROOKS
Last Name:HORNE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 SCUFFLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-6538
Mailing Address - Country:US
Mailing Address - Phone:912-429-8401
Mailing Address - Fax:
Practice Address - Street 1:900 MOHAWK ST STE E
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1768
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant