Provider Demographics
NPI:1679654982
Name:ZIELINSKI, HENRY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:JOHN
Last Name:ZIELINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 BROOKSTONE WALK NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8439
Mailing Address - Country:US
Mailing Address - Phone:770-597-0045
Mailing Address - Fax:
Practice Address - Street 1:5825 BROOKSTONE WALK NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8439
Practice Address - Country:US
Practice Address - Phone:770-597-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000680127CMedicaid
GA000680127CMedicaid
GA02BBCRWMedicare ID - Type Unspecified