Provider Demographics
NPI:1386746824
Name:ACKA, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ACKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0177
Mailing Address - Country:US
Mailing Address - Phone:434-584-0060
Mailing Address - Fax:434-584-0064
Practice Address - Street 1:1363 W DANVILLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-3901
Practice Address - Country:US
Practice Address - Phone:434-584-0060
Practice Address - Fax:434-584-0064
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4301300001Medicare NSC