Provider Demographics
NPI:1134754393
Name:EAVES, JOANNE
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:EAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BELLINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:BEECH ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29842-8646
Mailing Address - Country:US
Mailing Address - Phone:803-522-8204
Mailing Address - Fax:
Practice Address - Street 1:5010 CHARLIE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9180
Practice Address - Country:US
Practice Address - Phone:803-522-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider