Provider Demographics
NPI:1225086903
Name:BANIT, DAXES M (MD)
Entity Type:Individual
Prefix:
First Name:DAXES
Middle Name:M
Last Name:BANIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 WATSON BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8536
Mailing Address - Country:US
Mailing Address - Phone:478-953-4563
Mailing Address - Fax:478-953-4683
Practice Address - Street 1:3051 WATSON BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8536
Practice Address - Country:US
Practice Address - Phone:478-953-4563
Practice Address - Fax:478-953-4683
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052884207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA093299102B-PERRYMedicaid
GA093299102B-PERRYMedicaid
G25464Medicare UPIN