Healthcare Provider Details

I. General information

NPI: 1508928474
Provider Name (Legal Business Name): HENRY AUCOIN P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 13TH. AVE SUITE B300
COLUMBUS GA
31901-3700
US

IV. Provider business mailing address

1538 13TH. AVE. SUITE B300
COLUMBUS GA
31901-3700
US

V. Phone/Fax

Practice location:
  • Phone: 706-321-9300
  • Fax: 706-321-9384
Mailing address:
  • Phone: 706-321-9300
  • Fax: 706-321-9384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number02220
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberP.A.-1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: