Healthcare Provider Details

I. General information

NPI: 1245265925
Provider Name (Legal Business Name): DONALD LENTZ HENSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 BROWNS MILL RD
JOHNSON CITY TN
37604-1417
US

IV. Provider business mailing address

159 HAYS FARMS CT
JOHNSON CITY TN
37615-4567
US

V. Phone/Fax

Practice location:
  • Phone: 423-631-0432
  • Fax: 423-631-0284
Mailing address:
  • Phone: 423-202-1496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD0000021403
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: