Provider Demographics
NPI:1417194705
Name:HAZLE, JAMES DUANE
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DUANE
Last Name:HAZLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 HIGHWAY 172 W
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:GA
Mailing Address - Zip Code:30624-2529
Mailing Address - Country:US
Mailing Address - Phone:706-436-9022
Mailing Address - Fax:
Practice Address - Street 1:2275 HIGHWAY 172 W
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:GA
Practice Address - Zip Code:30624-2529
Practice Address - Country:US
Practice Address - Phone:706-436-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other