Provider Demographics
NPI:1285611061
Name:STURCKEN, DORIS (NP-C)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:
Last Name:STURCKEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GREENE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2385
Mailing Address - Country:US
Mailing Address - Phone:706-722-6900
Mailing Address - Fax:706-722-5118
Practice Address - Street 1:701 GREENE ST STE 200
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2385
Practice Address - Country:US
Practice Address - Phone:706-722-6900
Practice Address - Fax:706-722-5118
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2548363L00000X
GARN067070NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA969223386BMedicaid
GA969223386EMedicaid
GA969223386CMedicaid
GA969223386DMedicaid
GA969223386GMedicaid
GA969223386FMedicaid
SCNP0399Medicaid
SCP847947437Medicare PIN
GA969223386DMedicaid
GA969223386EMedicaid