1336395193 NPI number — MS. FLORENCE MICHELLE HENSON LPTA

Table of content: MS. FLORENCE MICHELLE HENSON LPTA (NPI 1336395193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336395193 NPI number — MS. FLORENCE MICHELLE HENSON LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSON
Provider First Name:
FLORENCE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTANEZ
Provider Other First Name:
FLORENCE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336395193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3051 WATSON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARNER ROBINS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31093-8536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-953-7556
Provider Business Mailing Address Fax Number:
478-953-4677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3051 WATSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARNER ROBINS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31093-8536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-953-7556
Provider Business Practice Location Address Fax Number:
478-953-4677
Provider Enumeration Date:
08/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  001343 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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