Provider Demographics
NPI:1932741865
Name:HANEY, JIMMY LEE
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:LEE
Last Name:HANEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 GARDNER CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1973
Mailing Address - Country:US
Mailing Address - Phone:757-585-8155
Mailing Address - Fax:
Practice Address - Street 1:5318 GARDNER CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1973
Practice Address - Country:US
Practice Address - Phone:757-585-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider