Provider Demographics
NPI:1346975992
Name:HETZEL, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HETZEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 ROBINSON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2209
Mailing Address - Country:US
Mailing Address - Phone:706-957-3099
Mailing Address - Fax:
Practice Address - Street 1:1826 ROBINSON DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2209
Practice Address - Country:US
Practice Address - Phone:706-957-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program