Provider Demographics
NPI:1619346921
Name:HANKERSON, BOISE EUGENE SR (CPS)
Entity Type:Individual
Prefix:MR
First Name:BOISE
Middle Name:EUGENE
Last Name:HANKERSON
Suffix:SR
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 BARRY DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5284
Mailing Address - Country:US
Mailing Address - Phone:706-869-2177
Mailing Address - Fax:
Practice Address - Street 1:2730 BARRY DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5284
Practice Address - Country:US
Practice Address - Phone:706-869-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other