Provider Demographics
NPI:1326315680
Name:HINT, HARRIET CARLEEN (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:HARRIET
Middle Name:CARLEEN
Last Name:HINT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GREENCASTLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2945
Mailing Address - Country:US
Mailing Address - Phone:770-631-1040
Mailing Address - Fax:770-631-1019
Practice Address - Street 1:105 GREENCASTLE RD STE A
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2945
Practice Address - Country:US
Practice Address - Phone:770-631-1040
Practice Address - Fax:770-631-1019
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN090519363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG45045Medicaid