Provider Demographics
NPI:1194775999
Name:HENDERSON, GROVER CLEVELAND III (MD)
Entity type:Individual
Prefix:DR
First Name:GROVER
Middle Name:CLEVELAND
Last Name:HENDERSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:139 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-8516
Mailing Address - Country:US
Mailing Address - Phone:864-223-4477
Mailing Address - Fax:864-943-4337
Practice Address - Street 1:303 W ALEXANDER AVE
Practice Address - Street 2:SUITE F
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4078
Practice Address - Country:US
Practice Address - Phone:864-227-1144
Practice Address - Fax:864-943-4337
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC008527174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist