Provider Demographics
NPI:1750313706
Name:HUNTER, GERALD HAYDEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:HAYDEN
Last Name:HUNTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 S RIVER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WOODLEAF
Mailing Address - State:NC
Mailing Address - Zip Code:27054-9557
Mailing Address - Country:US
Mailing Address - Phone:704-278-4114
Mailing Address - Fax:
Practice Address - Street 1:612 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2732
Practice Address - Country:US
Practice Address - Phone:704-210-5661
Practice Address - Fax:704-210-5660
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49695367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051211Medicaid
NC2617550Medicare ID - Type Unspecified