HERTEL, JOACHIM E (MD)

Provider Demographics

• NPI: 1538146303
• Name: HERTEL, JOACHIM E (MD)
• Entity type: Individual
• Prefix: DR
• First Name: JOACHIM
• Middle Name: E
• Last Name: HERTEL
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 29 MEMORIAL MEDICAL DR
• Mailing Address - City: GREENVILLE
• Mailing Address - State: SC
• Mailing Address - Zip Code: 29605-4407
• Mailing Address - Country: US
• Mailing Address - Phone: 864-220-1200
• Mailing Address - Fax: 864-220-1888
• Practice Address - Street 1: 29 MEMORIAL MEDICAL DR
• Practice Address - City: GREENVILLE
• Practice Address - State: SC
• Practice Address - Zip Code: 29605-4407
• Practice Address - Country: US
• Practice Address - Phone: 864-220-1200
• Practice Address - Fax: 864-220-1888
• Is Sole Proprietor?: Yes
• Enumeration Date: 2005-12-22
• Last Update Date: 2024-12-03

Provider Licenses

State	License ID	Taxonomies
SC	MD23113	207RN0300X, 207RN0300X
SC	23113	207RN0300X
GA	35903GA	207RN0300X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	207RN0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Nephrology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
GA	000510309AX	Medicaid
GA	000510309L	Medicaid
GA	000510309P	Medicaid
GA	000510309AT	Medicaid
GA	000510309AU	Medicaid
GA	000510309AY	Medicaid
GA	000510309AW	Medicaid
GA	000510309AZ	Medicaid
GA	000510309R	Medicaid
GA	000510309U	Medicaid
SC	G35093	Medicaid
GA	000510309BC	Medicaid
GA	000510309BD	Medicaid
GA	000510309F	Medicaid
GA	000510309I	Medicaid
GA	000510309AV	Medicaid
GA	000510309BA	Medicaid
GA	000510309BB	Medicaid
GA	000510309C	Medicaid
SC	G35903	Medicaid
GA	000510309AS	Medicaid
GA	000510309AU	Medicaid
GA	000510309BA	Medicaid
GA	000510309F	Medicaid
GA	000510309M	Medicaid
SC	MD23113	Other	PROFESSIONAL LICENSE #
GA	000510309BD	Medicaid
GA	000510309C	Medicaid
GA	1538146303	Other	BCBS-GA
GA	338045	Other	WELLCARE OF GEORGIA
GA	000510309BA	Medicaid
GA	000510309BD	Medicaid
GA	000510309R	Medicaid
GA	000510309AW	Medicaid