Healthcare Provider Details

I. General information

NPI: 1538105044
Provider Name (Legal Business Name): JOSEPH M UNION JR. PAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 10/25/2022
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST
MACON GA
31201-2102
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 478-331-1000
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax: 954-839-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number003365
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number3365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: