=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811231012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARRELL WAYNE FIXLER JR. RRT, RCP, NRP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2012
-----------------------------------------------------
Last Update Date | 05/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1499 FAIR RD
-----------------------------------------------------
City | STATESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30458-1683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-486-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1499 FAIR RD
-----------------------------------------------------
City | STATESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30458-1683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-486-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | SC5042215
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | PMD531563
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 146L00000X
-----------------------------------------------------
Taxonomy Name | Paramedic
-----------------------------------------------------
License Number | P028590
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2278P4000X
-----------------------------------------------------
Taxonomy Name | Patient Transport Certified Respiratory Therapist
-----------------------------------------------------
License Number | 009306
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 2279C0205X
-----------------------------------------------------
Taxonomy Name | Critical Care Registered Respiratory Therapist
-----------------------------------------------------
License Number | 009306
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 2278C0205X
-----------------------------------------------------
Taxonomy Name | Critical Care Certified Respiratory Therapist
-----------------------------------------------------
License Number | 2039
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------