Basic Information
| Provider Information | |||||||||
| NPI: | 1235484312 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENKEL | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 117265 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303687265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063695440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1305 JENNINGS MILL RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | WATKINSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306777241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066135880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 3551 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 86314 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.