Provider Demographics
NPI:1740285873
Name:HESS, HERBERT MAYNARD (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:MAYNARD
Last Name:HESS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:620 JL WHITE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:706-692-9080
Mailing Address - Fax:706-692-1199
Practice Address - Street 1:620 JL WHITE DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143
Practice Address - Country:US
Practice Address - Phone:706-692-9080
Practice Address - Fax:706-692-1199
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8536174400000X
GA002799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00869085CMedicaid
GA00869085CMedicaid