Provider Demographics
NPI:1346046513
Name:HINES, CANSTRELL DARRISAW
Entity type:Individual
Prefix:
First Name:CANSTRELL
Middle Name:DARRISAW
Last Name:HINES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 HINES RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-4151
Mailing Address - Country:US
Mailing Address - Phone:478-278-3613
Mailing Address - Fax:
Practice Address - Street 1:59 HINES RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-4151
Practice Address - Country:US
Practice Address - Phone:478-278-3613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory