Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME63921 | FL |
Y | 111NI0900X | Internist | ME63921 | FL |
N | 207RA0401X | Internist - Addiction Medicine | ME63921 | FL |
N | 207RG0300X | Geriatric Medicine | ME63921 | FL |
NPI | 1144234535 |
---|---|
Provider Name | Dr. Patrick T Hennessey |
First Address | Fort Stewart, GA 31314-5641 |
Second Address | Fort Stewart, GA 31314-5641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F55103 | (02) |