NPIMap

Organization Active NPI

Hazlehurst Primary Care, PC

  • Specialist
  • Hazlehurst, GA
National Provider Identifier
1497935407
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
HAZLEHURST PRIMARY CARE, PC
Practice address
17 Johnson St
Hazlehurst, GA 31539-6243
Phone
(912) 375-5507
Fax
(912) 375-2172
NPI assigned
Nov 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

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

Authorized official

Name
Shelly Harrell, MHSA
Title
Director
Phone
(912) 538-5508

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

17 Johnson St
Hazlehurst, GA 31539-6243

Mailing address

PO Box 647
Hazlehurst, GA 31539-0647
Phone (912) 375-5507

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1497935407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 647",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315390647",
            "telephone_number": "912-375-5507",
            "fax_number": "912-375-2172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 JOHNSON ST",
            "city": "HAZLEHURST",
            "state": "GA",
            "postal_code": "315396243",
            "telephone_number": "912-375-5507",
            "fax_number": "912-375-2172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZLEHURST PRIMARY CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "HARRELL",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "912-538-5508",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hazlehurst, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; 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.