Jose Mira Hernandez, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

052133 Issued in GA

Practice address

3011 Hampton Ave
Brunswick, GA 31520-4264

Phone

(912) 261-2669

Fax

(912) 261-0561

NPI assigned

Dec 6, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeastern Pathology Associate

  • General Acute Care Hospital
  • Brunswick, GA
  • NPI 1558577346
  NPD (past)
• Southeastern Pathology Associates PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Brunswick, GA
  • NPI 1992963268
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209427200000",
    "number": "1497739130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30309",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294170309",
            "telephone_number": "843-554-9300",
            "fax_number": "843-566-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 HAMPTON AVE",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315204264",
            "telephone_number": "912-261-2669",
            "fax_number": "912-261-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRA HERNANDEZ",
        "first_name": "JOSE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2008-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "052133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000970263A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joalice Miller, LPC
• Kimberly E Miller, RN
• Timothy W Miller, AA-C
• Melissa Anne Minix, R.PH.
• John Shreve Minkowski, MD
• Miracle Home Care Inc.
• Charles W. Mitchell, M.D.
• Ernest Edward Mitchell III, PHARMD
• Heather Cone Mitchell, CRNA
• Patsy Mitchell, D.O.

• Anatomic Pathology & Clinical Pathology Physician in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.