Provider Demographics
NPI:1285848846
Name:BANKS, DOUGLAS SANTRELL (PROSTHETISTS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:SANTRELL
Last Name:BANKS
Suffix:
Gender:M
Credentials:PROSTHETISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 CHARMANT PL
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4358
Mailing Address - Country:US
Mailing Address - Phone:601-856-8360
Mailing Address - Fax:
Practice Address - Street 1:199 CHARMANT PL
Practice Address - Street 2:SUITE 4
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4358
Practice Address - Country:US
Practice Address - Phone:601-856-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS224P00000X224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist