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General NPI Number Information
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NPI Number | 1609112911
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Entity Type | Individual
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Provider Name | JAMES DANIELS HIS
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Gender | Male
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Dates
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Enumeration Date | 12/14/2012
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 102 OAK ST
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City | STATESBORO
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State | GA
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Zip | 30458-4852
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Country | US
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Telephone | 912-489-1787
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Fax |
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Provider Business Mailing Address
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Address Line | 11900 HWY 280 E
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City | ELLABELL
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State | GA
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Zip | 31308-3603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HADS000813
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HAD-0468
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License Number State | SC
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