Provider Demographics
NPI:1689786055
Name:POSAS, HERNAN N JR (MD)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:N
Last Name:POSAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4274 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6814
Mailing Address - Country:US
Mailing Address - Phone:229-242-1234
Mailing Address - Fax:229-247-8110
Practice Address - Street 1:4274 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-242-1234
Practice Address - Fax:229-247-8110
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0320262084N0402X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00570567BMedicaid
13BDDGFMedicare ID - Type Unspecified
GA00570567BMedicaid