Individual
GINA LANELLE HURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D
Contact information
Practice address
SUITE125-E 1000JOHNSON FERRY ROAD, SUITE125-E, MARRIETA, GA 30068
(770) 579-0802
(770) 579-0340
Mailing address
SUITE125-E 1000JOHNSON FERRY ROAD, MARRIETA, GA 30068
(770) 579-0802
(770) 579-0340
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
011336
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011336
LICENSE
GA
01
—
582625375
TAX ID
GA
Enumeration date
11/21/2006
Last updated
08/20/2015
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