Basic Information
| Provider Information | |||||||||
| NPI: | 1598801524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4523 HIGHWAY 246 N | ||||||||
| Address2: | |||||||||
| City: | HODGES | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296539705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8643747363 | ||||||||
| FaxNumber: | 7065676036 | ||||||||
| Practice Location | |||||||||
| Address1: | 367 CLEAR CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | LAVONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305534173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063567800 | ||||||||
| FaxNumber: | 7065676036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 12/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN079744 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 025919180E | 05 | GA | MEDICAID | 025919180F | 05 | GA | MEDICAID | 025919810A | 05 | GA | MEDICAID | 025919180B | 05 | GA | MEDICAID |