Healthcare Provider Details

I. General information

NPI: 1174564488
Provider Name (Legal Business Name): JOSEPH PAUL RECTENWALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/30/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 13TH ST STE 20
AUGUSTA GA
30901
US

IV. Provider business mailing address

811 13TH ST STE 20
AUGUSTA GA
30901
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-3401
  • Fax: 706-724-6540
Mailing address:
  • Phone: 706-724-6540
  • Fax: 706-722-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number052206
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number052206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: