Provider Demographics
NPI:1144404898
Name:HURT, CHRISTIN COLLIER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIN
Middle Name:COLLIER
Last Name:HURT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTIN
Other - Middle Name:NELL
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5252
Mailing Address - Country:US
Mailing Address - Phone:601-910-3004
Mailing Address - Fax:
Practice Address - Street 1:815 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5252
Practice Address - Country:US
Practice Address - Phone:601-910-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203307207N00000X
MS21939207N00000X
NC2013-01463207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1002364Medicaid