Healthcare Provider Details

I. General information

NPI: 1811231012
Provider Name (Legal Business Name): DARRELL WAYNE FIXLER JR. RRT, RCP, NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FAIR RD
STATESBORO GA
30458-1683
US

IV. Provider business mailing address

1499 FAIR RD
STATESBORO GA
30458-1683
US

V. Phone/Fax

Practice location:
  • Phone: 912-486-1000
  • Fax:
Mailing address:
  • Phone: 912-486-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberSC5042215
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD531563
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP028590
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2278P4000X
TaxonomyPatient Transport Certified Respiratory Therapist
License Number009306
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number009306
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number2039
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: