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General NPI Number Information
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NPI Number | 1710324157
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Entity Type | Individual
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Provider Name | MATTHEW DOUGLAS HENSLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 302 UNIVERSITY PKWY
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City | AIKEN
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State | SC
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Zip | 29801-6302
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Country | US
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Telephone | 803-641-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 TROUPE ST
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City | AUGUSTA
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State | GA
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Zip | 30904-4480
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Country | US
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Telephone | 706-737-4575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 080739
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License Number State | GA
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