Basic Information
Provider Information | |||||||||
NPI: | 1801058581 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HERSHMAN | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 12187 | ||||||||
Address2: |   | ||||||||
City: | AUGUSTA | ||||||||
State: | GA | ||||||||
PostalCode: | 309142187 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7068639595 | ||||||||
FaxNumber: | 7068688375 | ||||||||
Practice Location | |||||||||
Address1: | 1600 COIT RD STE 305 | ||||||||
Address2: |   | ||||||||
City: | PLANO | ||||||||
State: | TX | ||||||||
PostalCode: | 750756172 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7068639595 | ||||||||
FaxNumber: | 7068688375 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2008 | ||||||||
LastUpdateDate: | 04/29/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/29/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 305277 | NC | N |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 208200000X | MD0000063029 | TN | N |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 208200000X | 0101273129 | VA | N |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 208200000X | ME153167 | FL | N |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 208200000X | 70263 | GA | N |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 208200000X | 29430 | MS | N |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   | 208600000X | Q1993 | TX | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208200000X | Q1993 | TX | Y |   | Allopathic & Osteopathic Physicians | Plastic Surgery |   |
No ID Information.