Individual
JOSE MIRA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3011 HAMPTON AVE, BRUNSWICK, GA 31520-4264
(912) 261-2669
(912) 261-0561
Mailing address
PO BOX 30309, CHARLESTON, SC 29417-0309
(843) 554-9300
(843) 566-8780
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
052133
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000970263A
—
GA
Enumeration date
12/06/2005
Last updated
04/29/2008
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