Provider Demographics
NPI:1689400509
Name:HURT, JADEN SHEMAR
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:SHEMAR
Last Name:HURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 ELMA G MILES PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4004
Mailing Address - Country:US
Mailing Address - Phone:912-532-9774
Mailing Address - Fax:
Practice Address - Street 1:481 ELMA G MILES PKWY STE B
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4004
Practice Address - Country:US
Practice Address - Phone:912-532-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-23-282560106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician