Provider Demographics
NPI:1366596728
Name:HAKES, GEORGIA LEE (RN)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:LEE
Last Name:HAKES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:LEE
Other - Last Name:SINGLETARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-4136
Mailing Address - Country:US
Mailing Address - Phone:518-752-5555
Mailing Address - Fax:
Practice Address - Street 1:1 CONWAY CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2108
Practice Address - Country:US
Practice Address - Phone:518-274-6525
Practice Address - Fax:518-274-6511
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275560-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82668-2OtherRN
NY275560-1OtherRN