Healthcare Provider Details

I. General information

NPI: 1699722892
Provider Name (Legal Business Name): PAUL EDWARD HENSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CLEVELAND ST STE 350
CROSSVILLE TN
38555-2898
US

IV. Provider business mailing address

49 CLEVELAND ST STE 350
CROSSVILLE TN
38555-2898
US

V. Phone/Fax

Practice location:
  • Phone: 931-459-1120
  • Fax:
Mailing address:
  • Phone: 931-423-6970
  • Fax: 423-697-1798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD029178
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: