Provider Demographics
NPI:1003635699
Name:HURLING, LAURENCE SR
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:
Last Name:HURLING
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 WELLBORN RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5438
Mailing Address - Country:US
Mailing Address - Phone:404-310-6191
Mailing Address - Fax:
Practice Address - Street 1:1984 WELLBORN RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5438
Practice Address - Country:US
Practice Address - Phone:404-310-6191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010271225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist