Provider Demographics
NPI:1295854438
Name:HURST, SHAMIRA (BSW)
Entity Type:Individual
Prefix:
First Name:SHAMIRA
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE B-100
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1619
Mailing Address - Country:US
Mailing Address - Phone:334-270-0983
Mailing Address - Fax:334-270-1187
Practice Address - Street 1:4250 EXECUTIVE PARK DRIVE
Practice Address - Street 2:SUITE B-100
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1619
Practice Address - Country:US
Practice Address - Phone:334-270-0983
Practice Address - Fax:334-270-1187
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator