Provider Demographics
NPI:1689850810
Name:HENRIQUEZ, OSWALDO ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:OSWALDO
Middle Name:ANDRES
Last Name:HENRIQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSWALDO
Other - Middle Name:ANDRES
Other - Last Name:HENRIQUEZ-AJAMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4441 ATLANTA RD SE STE 205
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6442
Mailing Address - Country:US
Mailing Address - Phone:770-801-5020
Mailing Address - Fax:770-435-6722
Practice Address - Street 1:4441 ATLANTA RD SE STE 205
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6442
Practice Address - Country:US
Practice Address - Phone:770-801-5020
Practice Address - Fax:770-435-6722
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002659174400000X
GA70141207YX0007X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck