Provider Demographics
NPI:1083133763
Name:HURTEAU PLASTIC SURGERY, P.C.
Entity type:Organization
Organization Name:HURTEAU PLASTIC SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HURTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-202-0072
Mailing Address - Street 1:1000 HAWTHORNE AVE STE N
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2168
Mailing Address - Country:US
Mailing Address - Phone:706-202-0072
Mailing Address - Fax:
Practice Address - Street 1:1000 HAWTHORNE AVE STE N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2168
Practice Address - Country:US
Practice Address - Phone:706-202-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017206208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty