Provider Demographics
NPI:1598466237
Name:HURST, DEIRDEE
Entity Type:Individual
Prefix:
First Name:DEIRDEE
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3863 GA 138 HIGHWAY
Mailing Address - Street 2:SUITE 1545
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281
Mailing Address - Country:US
Mailing Address - Phone:770-712-9177
Mailing Address - Fax:678-276-8198
Practice Address - Street 1:3863 GA 138 HIGHWAY SUITE 1545
Practice Address - Street 2:SUITE 1545
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-1493
Practice Address - Country:US
Practice Address - Phone:770-712-9917
Practice Address - Fax:678-276-8198
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)