Healthcare Provider Details

I. General information

NPI: 1689786055
Provider Name (Legal Business Name): HERNAN N POSAS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4274 N VALDOSTA RD
VALDOSTA GA
31602-6814
US

IV. Provider business mailing address

4274 N VALDOSTA RD
VALDOSTA GA
31602-6814
US

V. Phone/Fax

Practice location:
  • Phone: 229-242-1234
  • Fax: 229-247-8110
Mailing address:
  • Phone: 229-242-1234
  • Fax: 229-247-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number032026
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number032026
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: