Provider Demographics
NPI:1508928474
Name:AUCOIN, HENRY (PAC)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:AUCOIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 13TH. AVE.
Mailing Address - Street 2:SUITE B300
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3700
Mailing Address - Country:US
Mailing Address - Phone:706-321-9300
Mailing Address - Fax:706-321-9384
Practice Address - Street 1:1538 13TH. AVE
Practice Address - Street 2:SUITE B300
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3700
Practice Address - Country:US
Practice Address - Phone:706-321-9300
Practice Address - Fax:706-321-9384
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02220363A00000X
ALP.A.-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R79944Medicare UPIN
GA97WCFQSMedicare ID - Type Unspecified