Provider Demographics
NPI:1669406211
Name:HENSON, GEOFFREY ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:ALAN
Last Name:HENSON
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:PO BOX 890580
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0580
Mailing Address - Country:US
Mailing Address - Phone:540-427-4406
Mailing Address - Fax:540-427-4915
Practice Address - Street 1:AUGUSTA MEDICAL CENTER
Practice Address - Street 2:78 MEDICAL CENTER DRIVE
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-1000
Practice Address - Country:US
Practice Address - Phone:540-932-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240139207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010308062Medicaid
VA011252A90Medicare PIN
VA010308062Medicaid