Provider Demographics
NPI:1487184917
Name:HURTIG, CARL VICTOR (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:VICTOR
Last Name:HURTIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5629 HWY 21 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326
Mailing Address - Country:US
Mailing Address - Phone:912-295-2133
Mailing Address - Fax:912-295-5924
Practice Address - Street 1:5629 HWY 21 SOUTH
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-295-2133
Practice Address - Fax:912-295-5924
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84776207P00000X
IN11019197A390200000X
IN010833363A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program