Individual
DR. JACK DAVID HENEISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1214 N COLUMBIA AVE., UNIT D, RINCON, GA 31326
(912) 826-2132
(912) 826-2141
Mailing address
PO BOX 2089, RINCON, GA 31326-2089
(912) 826-2132
(912) 826-2141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
022780
GA
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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