Provider Demographics
NPI:1497935407
Name:HAZLEHURST PRIMARY CARE, PC
Entity Type:Organization
Organization Name:HAZLEHURST PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:912-538-5508
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-0647
Mailing Address - Country:US
Mailing Address - Phone:912-375-5507
Mailing Address - Fax:912-375-2172
Practice Address - Street 1:17 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6243
Practice Address - Country:US
Practice Address - Phone:912-375-5507
Practice Address - Fax:912-375-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty