Provider Demographics
NPI:1598801524
Name:JOSEPH, JAMES A (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4523 HIGHWAY 246 N
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:SC
Mailing Address - Zip Code:29653-9705
Mailing Address - Country:US
Mailing Address - Phone:864-374-7363
Mailing Address - Fax:706-567-6036
Practice Address - Street 1:367 CLEAR CREEK PKWY
Practice Address - Street 2:
Practice Address - City:LAVONIA
Practice Address - State:GA
Practice Address - Zip Code:30553-4173
Practice Address - Country:US
Practice Address - Phone:706-356-7800
Practice Address - Fax:706-567-6036
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN079744367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA025919180EMedicaid
GA025919180FMedicaid
GA025919810AMedicaid
GA025919180BMedicaid
GA43ZCBBD01Medicare Oscar/Certification
GA43ZCBBD01Medicare Oscar/Certification