Provider Demographics
NPI:1760106363
Name:HINSON, ANZELLA CRUMMEY (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANZELLA
Middle Name:CRUMMEY
Last Name:HINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ANZELLA
Other - Middle Name:CRUMMEY
Other - Last Name:HINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:4477 WAYCROSS HWY
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-4565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:903 WARD ST W STE B
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3536
Practice Address - Country:US
Practice Address - Phone:912-384-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN287195363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09220105OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
NCO-000001OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
GARN287195OtherGEORGIA BOARD OF NURSING