Provider Demographics
NPI:1235478751
Name:FERNANDER, JOSEPH DANIEL-BAILEY (CPHT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DANIEL-BAILEY
Last Name:FERNANDER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PEACHTREE EAST SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4045
Mailing Address - Country:US
Mailing Address - Phone:770-468-2026
Mailing Address - Fax:
Practice Address - Street 1:118 RIDGEVIEW CT
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1533
Practice Address - Country:US
Practice Address - Phone:770-584-2755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC003567183700000X
GA500107010023466183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician