Healthcare Provider Details

I. General information

NPI: 1144746751
Provider Name (Legal Business Name): DOUGLAS HANKIESON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 LILAC DR
PORTSMOUTH VA
23703-3760
US

IV. Provider business mailing address

3226 LILAC DR
PORTSMOUTH VA
23703-3760
US

V. Phone/Fax

Practice location:
  • Phone: 757-541-9199
  • Fax:
Mailing address:
  • Phone: 757-541-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: