Provider Demographics
NPI:1801981527
Name:HAUENSTEIN, JILL P (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:P
Last Name:HAUENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:P
Other - Last Name:HAUENSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2301 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6219
Mailing Address - Country:US
Mailing Address - Phone:706-733-7029
Mailing Address - Fax:706-733-1376
Practice Address - Street 1:2301 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6219
Practice Address - Country:US
Practice Address - Phone:706-733-7029
Practice Address - Fax:706-733-1376
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA263012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29706Medicare UPIN