Provider Demographics
NPI:1821219312
Name:HURT, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HURT
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 1:4192 SALEM RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4532
Mailing Address - Country:US
Mailing Address - Phone:770-788-2026
Mailing Address - Fax:
Practice Address - Street 1:4192 SALEM RD
Practice Address - Street 2:SUITE 400
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4532
Practice Address - Country:US
Practice Address - Phone:770-788-2026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN057139363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBLLBMedicare UPIN