Male or Other

Dr. Jack D. Heneisen M.D.

Family Medicine Physician in Rincon, GA(View on Map)

Full Name

Dr. Jack David Heneisen M.D.

NPI Number

1447310115

NPI Type

Individual Provider

Gender

Male

Enumeration Date

12/11/2006

Specialties

(Taxonomies)

Code

207Q00000X

Primary Taxonomy

Yes

Licenses

State

Georgia

License Number

022780

Contact
Information

Purpose

Mailing
Location

Address

PO BOX 2089
1214 N COLUMBIA AVE.

City

Rincon
Rincon

State

GA
GA

Postal Code

31326-2089
31326

Country

US
US

Telephone Number

(912) 826-2132
(912) 826-2132

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/08/2007

Provider Address

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