Provider Demographics
NPI:1285216655
Name:HOSE, TAKAI SADE (AHA INSTRUCTOR)
Entity Type:Individual
Prefix:
First Name:TAKAI
Middle Name:SADE
Last Name:HOSE
Suffix:
Gender:F
Credentials:AHA INSTRUCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 US HIGHWAY 319N LOT 38
Mailing Address - Street 2:
Mailing Address - City:NORMAN PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31771-6121
Mailing Address - Country:US
Mailing Address - Phone:229-454-5476
Mailing Address - Fax:
Practice Address - Street 1:1330 US HIGHWAY 319N LOT 38
Practice Address - Street 2:
Practice Address - City:NORMAN PARK
Practice Address - State:GA
Practice Address - Zip Code:31771-6121
Practice Address - Country:US
Practice Address - Phone:229-454-5476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06200872758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist