Healthcare Provider Details

I. General information

NPI: 1043215882
Provider Name (Legal Business Name): JOSEPH HENSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W MAIN ST
HOHENWALD TN
38462-1319
US

IV. Provider business mailing address

PO BOX 383
HOHENWALD TN
38462-0383
US

V. Phone/Fax

Practice location:
  • Phone: 931-796-5943
  • Fax: 931-796-1269
Mailing address:
  • Phone: 931-796-5943
  • Fax: 931-796-1269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: