Provider Demographics
NPI:1952901365
Name:HAZELL, CURL ORAL
Entity Type:Individual
Prefix:
First Name:CURL
Middle Name:ORAL
Last Name:HAZELL
Suffix:
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 1:2113 TORBAY DR
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-7429
Mailing Address - Country:US
Mailing Address - Phone:770-880-5590
Mailing Address - Fax:
Practice Address - Street 1:10300 INDUSTRIAL BLVD NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1477
Practice Address - Country:US
Practice Address - Phone:770-787-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist