MEDICARE: DR. JILL HENKE M.D.

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	207V00000X	Obstetrics & Gynecology Physician	52955	GA

General Provider Information

NPI Number	:	1548293426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL HENKE M.D.

Provider Business Mailing Address
First Line	:	5780 PEACHTREE DUNWOODY RD STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1513
Country	:	US
Telephone Number	:	404-303-8035
Fax Number	:	404-252-6794

Provider Business Practice Location Address
First Line	:	3890 JOHNS CREEK PKWY
Second Line	:	SUITE 300
City	:	SUWANEE
State	:	GA
Zip	:	30024-1284
Country	:	US
Telephone Number	:	678-775-2300
Fax Number	:

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	06/08/2021

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