Provider Demographics
NPI:1710113568
Name:HENRITZ, CASEY JANE (DO)
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:JANE
Last Name:HENRITZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:705 TOWN BLVD NE
Mailing Address - Street 2:SUITE 590
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3011
Mailing Address - Country:US
Mailing Address - Phone:404-855-2236
Mailing Address - Fax:404-793-6517
Practice Address - Street 1:705 TOWN BLVD NE
Practice Address - Street 2:SUITE 590
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3011
Practice Address - Country:US
Practice Address - Phone:404-855-2236
Practice Address - Fax:404-793-6517
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA68027207Q00000X
NC2012-01724207Q00000X
GA068027207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1710113568Medicaid
NC1710113568Medicaid