MEDICARE: DR. PAUL EDWARD HENSON JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	009515	GA

General Provider Information

NPI Number	:	1295200426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL EDWARD HENSON JR. MD

Provider Business Mailing Address
First Line	:	1837 WOOD VALLEY DR
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-3846
Country	:	US
Telephone Number	:	706-226-7790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 WOOD VALLEY DR
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-3846
Country	:	US
Telephone Number	:	706-226-7790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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