Provider Demographics
NPI:1669555934
Name:KURT P HOFMANN MD LLC
Entity type:Organization
Organization Name:KURT P HOFMANN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOFMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACS
Authorized Official - Phone:866-909-8354
Mailing Address - Street 1:303 HARRIS INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8850
Mailing Address - Country:US
Mailing Address - Phone:866-909-8354
Mailing Address - Fax:912-538-0770
Practice Address - Street 1:303 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8845
Practice Address - Country:US
Practice Address - Phone:866-909-8354
Practice Address - Fax:912-538-0770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000945106DMedicaid
GA051197OtherLICENSE
GA341202OtherWELLCARE
GA=========OtherTIN
GA051197OtherLICENSE