Healthcare Provider Details

I. General information

NPI: 1306981600
Provider Name (Legal Business Name): HAROLD KEVIN THOMAS HS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT CG-1122 U S COASTGUARD 2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

563 POINT PETER RD MSST KINGSBAY 91108
ST. MARYS GA
31558
US

V. Phone/Fax

Practice location:
  • Phone: 912-510-4719
  • Fax:
Mailing address:
  • Phone: 912-510-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: