NPIMap

Organization Active NPI

William C Hurst, Sr., D.M.D., P.C.

  • Pediatric Dentistry
  • Waycross, GA
National Provider Identifier
1063527745
Registry record updated Sep 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
007191 Issued in GA
Legal business name
WILLIAM C HURST, SR., D.M.D., P.C.
Practice address
410 Lister St
Waycross, GA 31501-5226
Phone
(912) 285-1218
Fax
(912) 285-9518
NPI assigned
Aug 20, 2006
Last updated
Sep 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Pam C Hurst
Title
Business Manager
Phone
(912) 285-1218

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 007191 GA Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 013177 GA

Addresses

Primary practice location

410 Lister St
Waycross, GA 31501-5226

Mailing address

6578 Hurst LN
Blackshear, GA 31516-1173
Phone (912) 449-1389

Other identifiers 4

IdentifierTypeStateIssuer
000067251BMedicaidGA
197090698AMedicaidGA
197090698BMedicaidGA
000067251CMedicaidGA

National Provider Directory

National Provider Directory

Locations

6578 Hurst Ln
Blackshear, GA 31516

410 Lister St
Waycross, GA 31501
Phone (912) 285-1218

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380153600000",
    "number": "1063527745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6578 HURST LN",
            "city": "BLACKSHEAR",
            "state": "GA",
            "postal_code": "315161173",
            "telephone_number": "912-449-1389",
            "fax_number": "912-449-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 LISTER ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015226",
            "telephone_number": "912-285-1218",
            "fax_number": "912-285-9518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM C HURST, SR., D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-20",
        "last_updated": "2013-09-26",
        "status": "A",
        "authorized_official_last_name": "HURST",
        "authorized_official_first_name": "PAM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "912-285-1218",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "007191",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "013177",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000067251B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197090698A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197090698B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000067251C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.