Healthcare Provider Details

I. General information

NPI: 1801981527
Provider Name (Legal Business Name): JILL P HAUENSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIA P HAUENSTEIN MD

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 WRIGHTSBORO RD
AUGUSTA GA
30904-6219
US

IV. Provider business mailing address

2301 WRIGHTSBORO RD
AUGUSTA GA
30904-6219
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-7029
  • Fax: 706-733-1376
Mailing address:
  • Phone: 706-733-7029
  • Fax: 706-733-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26301
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: